Continuity of Operations Planning for Public Health and Health Care Cathy Hockert, CEM, MPH, CBCP State Business Continuity Coordinator State of Minnesota Play Movie Continuity of Operations vs Service Continuation? COOP vs. Service Continuation COOP • Impact is usually local. • Physical structure and technology are affected. • Event is short in duration and triggers the COOP Recovery Phase. • No notice of the event. • Mainly affects buildings, equipment and technology. • One-time event. COOP vs. Service Continuation Service Continuation • May be local or global event • Physical structures and technology are initially not affected. • Some notice, although it may be short. • Mainly affects staffing levels. Specific to Pandemic: • Impact will be global • May last 6-8 weeks • Could have multiple waves Why have a COOP? Purpose of COOP • Ensuring continued performance of essential functions. • Reducing loss of life and minimizing damage. • Ensuring succession of key leaders. • Reducing or mitigating disruptions to operations. • Protecting essential assets. • Achieving a timely recovery and reconstitution. • Maintaining a test, training, and exercise program for viability. 5 Steps to COOP Planning Initiation Risk/Vulnerability Assessment Disaster Readiness Assessment – (Identification of essential functions & resources required) Plan Development Plan Implementation, Maintenance & Testing Who should be involved in COOP Planning? Who should be involved in COOP Planning? • It’s a team effort! • Personnel at every level of the organization, including: COOP Coordinator/Point-of-Contact (POC) COOP Planning Team Senior Management Management and staff Key Personnel with ―Institutional Knowledge‖ www.ksn.com/weather/weathergallery/wxphotos COOP Planning Considerations COOP plans must: • Be capable of implementation anytime, with and without warning, during duty and non-duty hours. • Provide full operational capability for essential functions not later than 12 hours after activation. • Be capable of sustaining operations for up to 30 days. Agencies must develop operating procedures and acquire resources necessary to sustain operations for up to 30 days. • Include regularly scheduled TT&E. Agencies must train members of their emergency staff and practice COOP procedures to ensure their skills stay current. Equipment and communications must be tested periodically to ensure that they are operable How do we start planning? • What are you vulnerable to? – Hazards – Risks • If that happened, what would be the impact to your agency/organization? What Elements Should be in a COOP Plan? • Essential Functions • Public Information • Delegation of • Vital Records Authority • Human Capital • Order of Succession • Security • Alternate Facilities • Logistics • Interoperable • Training and Communications Exercising Hazard Vulnerability Assessment • Probability of an event occurring and the impact the event would have on departmental and system wide operations Clara Barton Hospital Hoisington, Ks Hazard Vulnerability Analysis • Allows individual health agencies to identify and rank various risk and mitigating factors • Coordinate with local law enforcement and emergency management What are your Essential/Mission Critical Functions/Services? Essential Functions Identification and prioritization of essential functions necessary for agency continuity of operations. Essential functions include services that are: 1. Life Safety/Loss of Life 2. Public health 3. Food and Shelter 4. 24/7 Direct Care and Critical Ancillary Providers 5. Economic impact 6. Symbolic value Essential Functions agency specific • Define the agency mission and goals – What does your agency/organization do that is critical? • Identify the functions that are needed to accomplish the mission – Stack and rank priority/essential functions Essential Function Prioritization • Essential Function Prioritization ranking – Critical- function cannot be delayed – Important- function can be delayed but should be resumed as soon as possible – Non-essential- function can be delayed until normal business operations resume Essential Functions agency specific •Identify the tasks to accomplish essential functions •Job Action Sheets •Standard Operating Procedures •Identify the resources needed to support those tasks •Staffing requirements for each essential function are identified •Who is needed to ensure these essential functions continue? •Resource requirements for each essential function are identified •What ―things‖ do the people need to do the essential functions? •Critical data and data systems for each essential function are identified •What is needed from an IT standpoint to keep essential functions going? •Documented work-around procedures that explain how to continue providing care without computers, telephones, or vital medical machines Public Health Essential Functions • Communicable Disease Containment • Immunization • Women, Infants, and Children (WIC) • Family Planning • Maternal and Child Health (MCH) • Vital Statistics • Bioterrorism and Public Health Response • Human Resources • Fiscal Management • Public Information Officer (PIO) • Public Education • Home Health/Hospice/In-Home Care Program • Information System Support • Environmental Health Hospital Essential Functions • Patient Care including triage and treatment for inpatient and outpatient recipients • Patient movement to care centers with appropriate levels of care for patients • Postmortem care and disposition with appropriate community partners • Patient tracking including medical screenings • Long term care of elderly and other fragile populations • Lab capabilities consistent with facility need • Medical billing for procedures performed • Patient decontamination and stabilization • Facility and personnel security for patients and employees • Meeting standards of care as required by State regulation or accrediting organization Order of Succession vs Delegation of Authority • Order of Succession-list of individuals who would sequentially assume responsibility if the primary staff person is no longer able to carry out their functions • Delegation of Authority-positions in which the primary staff person has the authority to complete a particular task Order of Succession • Order of succession should be established for the highest positions of authority. i.e. Public Health Director, Hospital Administrator, Director of EMS • Line of succession should be established for the other leadership positions. i.e. Infection Control Nurse, ER Head, Safety Officer • Limitations on delegate authority should be listed – What can and can’t they do? (Helps limit confusion) Order of Succession • Rosters of trained/qualified personnel with the authority to perform essential functions and activities are maintained • Rules and procedures for implementing order of succession should be established initiating conditions notification methods terminating conditions Order of succession for essential functions • Three deep • Should include – Name and title – Point of contact information for 24/7 • Same successor may be named for different positions but avoid listing the same person as the first successor to several key positions Delegation of Authority • Delegation of Authority for each essential function should include: Name and title of delegate Position title and/or source of authority being delegated Point of contact information (phone, cell, pager, email…) Limitations (if any) or exceptions to the authority being delegated Date or event that triggers delegation (Activation of COOP plan) Date of termination or revocation (i.e. 30 day) Name, title and signature of the official empowered to delegate the authority specified Delegation of Authority to sign for Schedule Drugs POWER OF ATTORNEY FOR DEA ORDER FORMS I, Howard Rodenberg, being authorized to sign the current application for registration under the Controlled Substances Act or the Controlled Substances Import and Export Act, by these presents, do make, constitute, and appoint Michael McNulty and/or Barry Autrey, acting jointly or severally, as my true and lawful attorney in fact to act for and in my name only in such manner as I could act as a registrant under the Controlled Substances Act or the Controlled Substances Import and Export Act, with respect to receiving and transferring the Strategic National Stockpile. In this connection, my attorney in fact is specifically authorized to execute applications for books of official order forms and to sign such order forms in requisition for Scheduled II and IV controlled substances, in accordance with Section 308 of the Controlled Substances Act (21 U.S.C. 828) and part 1305 of Title 21 of the Code of Federal Regulations. I hereby ratify and confirm all that said attorney shall lawfully do or cause to be done by virtue hereof until notice of revocation in writing. Dated this _____ day of _______________, 2006. ________________________________________ Howard Rodenberg, M.D. Director of Health and Registrant pursuant to the Controlled Substances Act or the Controlled Substances Import and Export Act State of Kansas ) )ss County of Shawnee ) This instrument was acknowledged before me on the ______ day of _____________, 2006 by Howard Rodenberg, M.D., of the Kansas Department of Health and Environment, in his capacity as Director of Health and Registrant pursuant to the Controlled Substances Act or the Controlled Substances Import and Export Act. ____________________________ Notary Public My appointment expires: ____________________________ Alternate Facilities • Alternate facilities may be needed in the event that the health care facility is damaged, destroyed or overwhelmed • In hospital terms: Alternate Care Site (ACS) Site for hospital administration Site for hospital patient care functions • Define ACS Location for the delivery of medical care that occurs outside the acute hospital setting for patients who, under normal circumstances, would be treated as inpatients. Site may provide delivery of chronic care, the distribution of vaccines or medical countermeasures, or the quarantine, cohorting, or sequestration of potentially infected patients in the context of an easily transmissible infections disease • In Health Department terms this could be an MDS/ POD or alternate office location to continue office operations. Mass Medical Care with Scarce Resources: A Community Planning Guide, Health Systems Research Inc. Alternate Facilities • Consider: level and scope of care to be delivered foot print or size needed staffing requirements equipment and supplies ICS structure needed to integrate this facility with other health facilities in the event Security Staffing Communications EMS and other transportation issues rules/policies for operation • Mobile Morgues, NDMS, Field Hospitals Alternate Facilities • Plan should identify: Logistical considerations Provisions to sustain (utility services, food, water, operations for a period of up etc.) to 30 days Pre-positioning of resources Hot site- pre-wired 24/7 Operations Cold site- needs installation Considerations for the health Provisions for establishing and safety of relocated interoperable employees communications with all Physical security and access identified essential internal and external organizations, controls critical customers and the Co-location and duel use public Formal agreements (MOU, MOA) Alternate Facilities • Lessons Learned from Supplies (medical, Katrina: pharmaceutical, food, water) Consider pre-planning and Credentialing relationship building among Staffing agencies Patient tracking and Use of ICS documentation Public health (shower, Communication toilets, amenities, hygiene) Patient screening Security Pediatrics, geriatrics and Transportation (EMS, self psychiatric patients transported) Accessibility to the public Special populations Alternate Facilities • Challenges: lack of regional/state planning with clear delineation of responsibility and authority requirement that multiple entities work together who normally don’t lack of inducements to write a plan train and exercise licensing issues intra and interstate funding Standards of care- whole different presentation Interoperable Communications • Hardware/software that talks to each other and people that can communicate with each other in the same language (no codes) • Systems that need to work together include radios, phones, faxes, email, notification systems, IT systems, software, secure data systems • People that need to work together include Hospital, Clinic, Health Department, EMS, Fire, Law Enforcement, Emergency Management, Tribal Governments, Social Services… • Procedures and plans need to be written to specify how communication will work during COOP activation • Maintain the capability to communicate with internal and external clients, critical customers and the public. Information Technology • Information Technology (IT) needs should be a component of each essential function • Consider during planning: The essential function’s dependence on IT Managing the IT infrastructure during COOP activation Help desk tasks to support IT needs for identified essential functions Ability to provide remote access to programs Information Systems Support • Each essential service area must define their unique or critical information system requirements • Each essential service area must define their equipment needs and availability of this equipment Where is it stored How do we move it Where do we get it if we do not have it IT contingency plans • Designate responsible individuals/departments within the organization for moving and reestablishing IT • If relocation to an alternate facility is necessary, these services could be allocated to support organizations Public Information Your most important tool will be Public Information! • Have trained back up PIO and spokes persons • Plan for working out of a different location (i.e. JIC) Have a go-kit • Maintain contact lists for media • Develop alternate methods of dissemination • Develop templates during pre-planning to avoid creating during an emergency Message maps Press releases Information sheets How to find alternate sites Navigation of alternate sites (Signs) Vital Records • Vital Records Include: Emergency operating plans Policy and Procedural records Legal documents Financial records Personnel files Patient records Property management (inventory) Vital Records • Provisions for classified or sensitive data • Procedures for data backup and restoration • Identify location and accessibility to vital records • How often are your vital records on computer backed- up? • Do you have back-up records for all of the paper based records at your facility? • Where are your back-up files kept? On site or off? “With Planning and Preparation we ensure our safety today and preserve the future for younger generations” Human Resources- HR Policies • Plan for a reduction in work force – People impacted will want to leave – People afraid of personal safety will want to leave • Identify emergency policies for: Overtime Leave with pay Leave without pay Flexible leave options Vacation time Sick time • Identify plans for employees to work from home Tele-work • Potential health and safety issues Liability assessment by general counsel • Union issues (overtime issues,disaster support, etc) • Training on contingency planning • Employee Assistance Program (EAP) for mental health and health insurance provisions Human Resources-Employee Support • Essential Staff functioning during a COOP activation may have different support needs • Plans should include consideration for staff: Transportation Food and Lodging Child care Elder care Pet care • Consider developing a Family Preparedness Program • Encourage personal go-kits Safety and Security Concerns • Emergency Planning Committee • County Emergency Response Plan (Emergency Support Function 8). • Hospital EOPs • Ensure all necessary security and access controls are provided • Ensure that local law enforcement authorities are notified concerning the status of the emergency. Logistics • Food and water • Fuel • Lodging • Medical • Transportation • Health, Safety, Personal Command and Control • All response agencies are required to use Incident Command System (ICS) and follow National Incident Management System (NIMS) requirements (Hospitals use HICS) • Command staff provides overall coordination of the response and is the central communications point • Operations Section responsible for clinical duties including triage and treatment and directs all patient care resources • Logistics Section responsible for providing facilities, services (food, billeting, communications) and materials • Planning Section determines and provides for the achievement of each medical objective and manages human resources • Finance/Administrative Section responsible for maintaining accounting records, issuing purchase orders, and stressing facility wide documentation Command and Control • Form an Operations Team (OT) for your COOP Responsible for relocation activities Ensure all necessary and pre-planned communications systems are established and functioning properly Serve as the first shift operations at the alternate site • Provide cross training to personnel • Utilize Job Action Sheets (JAS) and Just in Time (JIT) training • Employ call-down roster Advise staff where to report What to bring Training and Exercising • Plans include annual individual and team training of agency COOP/COG emergency personnel. • Plans include annual agency testing and exercising of COOP/COG plans and procedures. • Plans include quarterly testing of emergency alert and notification procedures. • Plans include refresher orientation for COOP/COG staff. • Plans include inter-agency exercising of COOP/COG plans where applicable and feasible. COOP Activation and Implementation Implementation Phases • Phase I- Activation and Relocation – 0-12 Hours • Notify facilities, organizational elements and personnel of impending COOP activation • Activate plans to transfer to alternate facility, when necessary. • Instruct Ops team to ready facility/alternate facility. • Assemble documents/equipment required for essential functions at facility/alternate facility. • Secure facilities. • Continue essential functions at regular facility, if available, until alternate facility is ready if needed Implementation • Phase II- Alternate Facility/Work Site Operations – 12 Hours to Termination of Emergency • Provide guidance to preparedness team personnel and information to the public. • Identify and brief replacements for missing or rotating personnel • Commence full execution of operations supporting essential functions. • Phase III- Reconstitution – Termination of Emergency • Inform all personnel that the threat no longer exists. • Supervise return to normal operating facility or normal business practices at original facility. • Conduct an after action review of COOP plan execution and effectiveness. • Develop a Corrective Action Plan Questions? Exercising the Brain--People Respond the Way They are Trained • Time Magazine, April 25, 2005 • ―How to Get Out Alive— • From hurricanes to 9/11: What the science of evacuation reveals about how humans behave in the worst of times‖ People Respond the Way They are Trained ―Whether they’re in shipwrecks, hurricanes, plane crashes or burning buildings, people in peril experience remarkably similar stages. And the first one—even in the face of clear and urgent danger—is almost always a period of intense disbelief.‖ People Respond the Way They are Trained ―People who made it out of the World Trade Center waited an average of 6 minutes before heading downstairs.‖ (Some waited as long as 30 minutes) People Respond the Way They are Trained Problem—lack of data. ―Our brains require 8-10 seconds to handle each new piece of information. The more stress, the slower the process. Bombarded with new information, our brains shift into low gear when we need to move fast.‖ People Respond the Way They are Trained People caught up in disasters fall into 3 categories: – 10-15% remain calm and act quickly and efficiently – 15% completely freak out (weeping, screaming, hindering the evacuation) – The rest of the crowd are stunned, bewildered, and do very little – Reactions are not predictable based on a person’s every day personality People Respond the Way They are Trained Why do a few react calmly and quickly when most freeze? Many who make it out of disasters alive do something most others don’t—They go onto a plane, or into a theater, or their workplace and they study the exits— they imagine the scenario ahead of time, enabling themselves to work on automatic when the time comes to act, instead of wasting precious moments processing information. They exercise mentally. People Respond the Way They are Trained • Many of those people had been through disasters before, sometimes several. • This shows people can be trained to respond properly in a disaster, and that is the best reason to exercise. People Respond the Way They are Trained • ―Even in the World Trade Center, which had complicated escape routes and had been attacked once before, preparation levels were abysmal, we now know. Fewer than half the survivors had ever entered the stairwells before.‖ People Respond the Way They are Trained • Only 45% of 445 Trade Center workers interviewed before 9/11 knew the buildings had three stairwells. Only half had known the doors to the roof would be locked. www.ksn.com/weather/weathergallery/wxphotos Questions????