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Nurse Manager Resume Template THE WILSON GROUP GLOBAL VISION CONSORTIUM MEETING THE

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Nurse Manager Resume Template THE WILSON GROUP GLOBAL VISION CONSORTIUM MEETING THE Powered By Docstoc
					               THE WILSON GROUP
           GLOBAL VISION CONSORTIUM

  ______________________________

MEETING THE DISASTER CHALLENGE
 ENHANCING COMMUNITY CLINIC & HEALTH CENTER
        PREPAREDNESS AND RESPONSE

____________________________________________
           Clinic Emergency Preparedness Project (CEPP)
            California Primary Care Association (CPCA),
           Emergency Medical Services Authority (EMSA)

                        The Wilson Group 6-04             1
                       WELCOME
  CLINIC EMERGENCY PREPAREDNESS PROJECT
_________________________________________
  ATTENDEES:
   Emergency Planners
   Clinicians
   Administrators
   Clinic Consortia Staff


  STATEWIDE PARTICIPATION:
   June 18, ’04 - San Francisco Training
   June 24, ’04 - Eureka, Rural Northern Coast Training
   June 29, ’04 - Pasadena, Los Angeles County Training
                        The Wilson Group 6-04             2
 “MEETING THE DISASTER CHALLENGE:”

ENHANCING COMMUNITY CLINIC & HEALTH CENTER
        PREPAREDNESS & RESPONSE
  ___________________________________




                The Wilson Group 6-04        3
I. INTRODUCTION:
_________________________________

    OVERVIEW
       Goals & Objectives
       Agenda
       Project Background

       Review of Handouts



              The Wilson Group 6-04   4
       ENHANCING COMMUNITY CLINIC & HEALTH CENTER
               PREPAREDNESS & RESPONSE
                                   Building a Foundation of Capabilities:
     Commitment & Leadership     Tools, Templates, Plans, Supplies, Training

                                                       Mandates/Legislation
  New Goals, Roles

  Risk Threat/                                              Collaboration,
Lessons Learned                                              Partnership




                                                      OTHER DISASTERS


                                                        EARTHQUAKE
TERRORISM
                           The Wilson Group 6-04                       5
            TRAINING GOALS: BUILDING THE BRIDGE

            _________________________________

CLINIC: Internal Staff                                   External PARTNERS




•Clients / Staff / Volunteers                           •Government
•ERT                                                    • Hospitals / Community
•EOC                             Joint Mission          •Corporate(Business)
•Emergency Planning Committee    No Lag Time            •Schools
 Director                           No Gaps             •Utilities
                                The Wilson Group 6-04                          6
         A THREE LEVEL EMERGENCY MANAGEMENT
                 APPROACH TO PLANNING
                                                                  CLINIC EOP
                                                                  TEMPLATE
PROVIDE ENHANCED
CLINIC CAPABILITY:                                                Identify Essential
Intensive Support -                                               Functions, Revise Plans,
Communications; EOC-                                              Identify New Roles, Create
Coordinated, Intensive,                                           SOPS; Delegation of
and Sustained; Plans for                                          Authority; Lines of
Training                                                          Succession




               BUILD A PLANNING FOUNDATION –
               State, Regional, Operational & Local Jurisdiction
               Partner Teams

               (Support Operational Area, State, Federal Plans & Initiatives)


                                      The Wilson Group 6-04                              7
          PLANNING FOR EMERGENCY OPERATIONS:
              INTEGRATING STRATEGIES

        PLANNING
      ASSESSMENTS,                                                   PLANNING &
    RECOMMENDATIONS &                                                FACILITATING
         REVIEW                                                     PARTNERSHIPS
                                                                     & NETWORKS
• Directed at Leadership,
  Supporting Agencies, & Partners                            Access to Information From State,
                                                             Regional, Operational, & Local
                                                             Jurisdictions:

                                      REVISIONS OF
                                     EXISTING PLANS;
                                    INTEGRATED EOP
                                        TEMPLATE

   EOC RESPONSE PLAN
  & SOP ENHANCEMENTS                                         PLANNING – TRAINING &
                                                                  EVALUATION
• SEMS
• Alternate – Communication                                  • Consistent With Legislation
• Information Flow to Local                                  • State OES Policies & Laws
  Jurisdictions, Regions, & State




                                     The Wilson Group 6-04                                       8
    NEW CLINIC RESPONSE CAPABILITY:

Facilitates Rapid Disaster Response
    Immediate Response to Clients & Staff
    Timely Activation & Efficient Decisions


 Organizes Community Efforts


 Strengthens Coordination with Government


 Facilitates Access to Mutual Aid to Supply & Personnel


 Promotes Community Self-Sufficiency & Decision- Making
                             The Wilson Group 6-04         9
  GOALS /
OBJECTIVES:                       •    Minimize Community Clinic Losses
______________                    •    Prevent Further Casualties & Losses
______________                    •    Rescue / Recovery
                                  •    Provide Triage & Medical Operations
                                  •    Evacuate Injured
                                  •    Open Communications


 •   Reduce Property Loss
 •   Minimize Clinic Interruptions
 •   Minimize Life Style Impact
 •   Minimize Impact From Disaster
 •   Less Stress on Community



                            The Wilson Group 6-04                            10
                TRAINING OBJECTIVES:
  _______________________________________
Participants Will:


1. Understand Basics of Emergency Management & Clinic Roles


2. Understand How to Use Templates, Power-point Presentation &
   Other Tools


3. Understand Strategies for Initiating, Developing & Sustaining
   Clinic Emergency Management Program

                            The Wilson Group 6-04                  11
                    CLINIC EOP TRAINING:
                Provides Realistic Solutions
_____________________________________
•Increased Response Effectiveness & Risk Reduction

•Access To Resources; How To Maximize Resources
          •Staff with Military or Police Background
          •Executive Directors
          •Staff Person at Consortia Level
          •Operations Staff (who are more available than clinical staff)

•Community-Wide Emergency Response Coordination

•Clinic Leverage in Community Response Plans
                                 The Wilson Group 6-04                     12
PROJECT BACKGROUND:
How Clinics Became Involved
________________________________________




                  The Wilson Group 6-04    13
 PROJECT BACKGROUND:
      How Clinics Became Involved
__________________________________________________

- CPCA Emergency Preparedness Planning: Nora O’Brien, CPCA Regional Advocate
- CA EMSA Grant Funded Project Cheryl Starling, EMSA Bio-Terrorism Coordinator



      CLINIC EMERGENCY PREPAREDNESS PROJECT (CEPP):
       To Increase Clinic Preparedness in 3 Pilot Regions of State:
            San Francisco
            Rural Northern Coast
            Los Angeles County


                                   The Wilson Group 6-04                         14
•EMSA / CEPP Partnership

CLINIC TEMPLATE & TRAINING:
 - Joint Effort Developing Deliverables & Objectives
__________________________________________


    •To Establish / Strengthen Relationships With Local Disaster Planning Community.


    •Develop a Template “All Hazards” Emergency Preparedness Plan.


    •Identify Clinic Emergency “Best Practices”


    •Develop a Risk Communication Template.


                                 The Wilson Group 6-04                        15
              CEPP FACILITATES:
            Deliverables & Objectives
______________________________________________
– Address Mental Health Issues in Disaster Response

– Involve CCHC Personnel in Drills & Exercises

– Define Roles of CCHC & Consortia in Disaster Response

– Create Train-the-Trainer Curriculum

– Determine Civil Liability Issues: CCHC Personnel Disaster Response




                               The Wilson Group 6-04                   16
 II.        RISK, THREAT, LESSONS LEARNED:
               Unexpected Roles For Clinics
_________________________________________________



 CLINIC & CONSORTIA EMERGENCY RESPONSE:


 •     SUCCESSES & CHALLENGES




                      The Wilson Group 6-04         17
                              CLINICS RESPOND
_______________________________________________


TERRORISM
                       Changing Face of Disaster Risk 9/11
--------------------

 EARTHQUAKES

                        Northridge 1/17/94 & Loma Prieta 9/17/89



                                  The Wilson Group 6-04            18
THREATS: CHAOS
       EMS & PUBLIC HEALTH SYSTEM IN TURMOIL
   _____________________________


   People in the Park                           Hospital Closures & Evacuations




                        CLINIC




                                                         Transport
                                                      Provider Delays
                        The Wilson Group 6-04                                     19
                          SCENARIOS
WHAT IF....
... Event Destroys Clinic & Community Partners?

… Clinic Buildings - Closed for Normal Business Activities As Result of
  Catastrophic Event?

... Event Creates Mass Casualties Including Clinic Employees?

... Extensive Fires & Flooding Occurs Near Clinics With No Access to
    Community Resources?




                             The Wilson Group 6-04                 20
      CLINIC IMPACT



MAJOR THREAT IMPLICATIONS:
• Lack of Coordination: County, City, & Clinics

• Limitations in Clinic Disaster Plan;
  Does not address coordination of personnel,
  supplies, & resources within county.

• Limitation in Identifying & Accessing Clinic
  Resources in County / Operational Area




                                  The Wilson Group 6-04   21
   REALITY: EXTENDED MEDICAL RESPONSE
______________________________________________

                   Week 1       Week 2     Week 3        Week 4       Week 5         Week 6
                    Convergence
                                       Environmental                  Public Health
                    on Hospitals,
    Incident                           Health                         Demands
                    & Clinics
                                                       Mental
     Impact                            Demands
                                                       Health
                                                      Demands


                     POTENTIAL EVENTS             Sewer                   EOC
   HAZMAT                            Clinic       Disruption              Closures
                       Water &       Evacuation                Vendor            People
       Hospital        Power                                   Problems          In the Park
      Evacuation       Loss
                                    Aftershocks
                                                                      Communicable
          EMS        Search &                   Debris &              Diseases
       Disruption    Rescue      Secondary Dead Bodies
                                 Incident
    Federal Response                                     Infectious
                                   The Wilson Group 6-04 Diseases                     22
      REALITY: MUTUAL AID - Over Time & Delays



     Day 1     Day 2      Day 3        Day 4        Day 5    Day 6
                                                                          Evacuation
                                                                           of People
   72 hours
   or longer                                                              Resources/
                                                                          Supplies In



                                       Mobile       EOC       Nurses/
                                       Vans        Support   Physicians


                                        Military
                                       Resources


Self-Sufficiency Window
                           The Wilson Group 6-04                               23
     WHAT WE HAVE: CHAOS




WHAT WE NEED: COHESIVENESS




               The Wilson Group 6-04   24
DISASTER RESPONSE: CLINIC LESSONS LEARNED



 CHALLENGE OF NEW ROLES - Experience Highlights
      ___________________________________________



  San Ysidro, San Diego – Fires


  North East Valley Health Corporation - Northridge




                              The Wilson Group 6-04    25
            CRISIS CHALLENGES: CLINIC IMPACT
__________________________________
                                         Loss of Staff by
                                          Injury / Death
            Loss of
      Operational Capacity




 Threat of Hospital
   Evacuation -                                             Loss of Credibility
                                                            With Public/Clients



Limited Documentation –                                     Loss of Public
 Reimbursement Issues                                       Health & Safety

                             The Wilson Group 6-04                            26
                             LESSONS LEARNED
                    EMERGENCY IMPACT: Clinics
         ___________________________________________
          INFLUX of PATIENTS - Congregate at Clinic
    ______________

•   Regular patients will report to familiar location

•   County or hospitals may send non-acute patients to clinics in emergency


•   Patients may delay visiting doctor until very ill (could be unwitting carriers of
    biological agent)



     Community Expectations


                                       The Wilson Group 6-04                            27
    The Local Challenge:

  You are on the front line.



WARNING




          The Wilson Group 6-04   28
EOP TEMPLATE INTRODUCTION

   KEY EMERGENCY MANAGEMENT CONCEPTS
      __________________________________________


           BUILDING A FOUNDATION FOR
         EMERGENCY RESPONSE /RECOVERY
    ____________________________________
           CRISIS / EMERGENCY MANAGEMENT PHASES

           EMERGENCY PREPAREDNESS COMMITTEE

           EOP / ICS / SEMS

           EOC / ERT / IM

           OPERATIONAL AREA
                              The Wilson Group 6-04   29
     EMERGENCY OPERATIONS PLAN

PR    PREPARING FOR EMERGENCIES
De   Designed to effectively & efficiently organize & coordinate response to major emergencies by:
·      - Managing & coordinating emergency operations
·      - Coordinating resources
·      - Coordinating mutual aid
·      - Resolving & prioritizing conflicting requests for support.
·      - Requesting & allocating resources from outside

      EOP Priorities
      1.   Save human lives.
      2.   Protect property.
      3.   Provide for the needs of survivors.
      4.   Provide public information.
      5.   Preserve government.
      6.   Restore essential services.
      7.   Restore the environment.



                                       The Wilson Group 6-04                               30
       CLINIC EMERGENCY OPERATIONS PLAN
       ___________________________________
•   GOALS, OBJECTIVES & POLICY

•   MITIGATION      - Assessment & Tools

•   PREPAREDNESS    - Key Clinic Roles & Responsibilities;
                    Continuity of Operations Resources/ Integration
                    Community- Wide Response
                    Training & Maintenance

•   RESPONSE        - Initial Actions
                    Emergency Management Organization
                    EOC Management & Operations


•   RECOVERY        - Recovery Tools, Restoration – Critical
                    Services, Documentation & After- Action
                    Reports Group 6-04
                     The Wilson                                       31
  KEY CONCEPTS: Emergency Management Cycle - “Standardized”
                ____________________________

    RECOVER
    Financial Relief,                                             MITIGATION:
    Restoration                                                   Codes, Standards,
                                        Mitigate                  Designs, Best Practices



                    Recover                                  Prepare

                                                                   PREPAREDNESS
                                       Respond                     Risk Management,
RESPONSE                                                           Evaluate Positions; Set
Activation of Additional Resources,                                Goals, Plans, Drills, Build
                                                                   on Existing Resources
Temporary Shelter & Support, Coordination,
Communication
                                     The Wilson Group 6-04                             32
          EOP TEMPLATE INTRODUCTION:

               KEY TERMS

• CEPP:      Clinic Emergency Preparedness Project


• EOP:       Emergency Operations Plan


• EOC:       Emergency Operations Center


• ICS:       Incident Command System



                  The Wilson Group 6-04              33
           EOP TEMPLATE INTRODUCTION:

                   KEY TERMS
_________________________________
• EMERGENCY PREPAREDNESS COMMITEE (EPC):
   • Guides development & maintenance of clinic’s emergency
     management program & development of its emergency
     operations plan

• EMERGENCY RESPONSE TEAM (ERT):
   • Consists of clinic staff who will fill core positions of EOC &
     manage clinic’s emergency response



                            The Wilson Group 6-04                     34
    EOP TEMPLATE INTRDUCTION:

              KEY TERMS

• ALTERNATE SITES/FACILITIES:
  - Locations other than primary facility where clinic operations will continue
  during an emergency


• EMERGENCY OPERATIONS CENTER (EOC):

   – Location at which management can coordinate department activities during
     an emergency.

   – Managed using ICS

   – EOC may be established in primary clinic facility or at an alternate site.


                                 The Wilson Group 6-04                            35
  INTRODUCTION:      KEY TERMS
 ______________________________
• MULTI-HAZARD APPROACH:
  – Evaluates all threats including impacts from all natural & man-make
    disasters, including technological threats, terrorism, & state of war.




                            The Wilson Group 6-04                      36
 Cornerstones of California Response
STANDARDIZED EMERGENCY MANAGEMENT SYSTEM
                             (SEMS)

                    Four Major Elements
            ---------------------------------------------------
               •INCIDENT COMMAND SYSTEM (ICS)


               •MULTI-AGENCY OR INTER-AGENCY COORDINATION


               •CALIFORNIA’S MUTUAL AID SYSTEM


               •OPERATIONAL AREAS



                         The Wilson Group 6-04                    37
   EOP TEMPLATE INTRODUCTION:

                    KEY TERMS
_________________________________
STANDARDIZED EMERGENCY MANAGEMENT SYSTEM
  (SEMS):

  – Mandatory System Established by Government Code Section 8607 (A) for
    Managing Response of Government Agencies to Multi-agency & Multi-
    jurisdiction Emergencies in CA

  – Incorporates Use of ICS




                              The Wilson Group 6-04                        38
                   EOP TEMPLATE INTRODUCTION:
                           KEY TERMS
    __________________________
OPERATIONAL AREA:

  – An intermediate level of state emergency organization, consisting of county &
    all political subdivisions within county area.

  – Clinics will coordinate their disaster response with

  “MEDICAL HEALTH OPERATIONAL AREA COORDINATOR (MHOAC)”




                               The Wilson Group 6-04                        39
                   EOP TEMPLATE INTRODUCTION:
                              KEY TERMS
  ______________________________
STANDARD OPERATING PROCEDURES (SOPs):

  – Pre-identified operating procedures that are basis for how organization
    operates;

  – SOPs - used routinely for day to day operations & operations & response to
    emergency situations;

  – SOPs are presented in form of checklists or Job Action Sheets




                                The Wilson Group 6-04                         40
       3.5 EOP TEMPLATE - EOC ORGANIZATION

         ICS Chart: ROLES & FUNCTIONS
___________________________________

                         Management

               Liaison                   Public Information
                                         Safety


  Operations     Planning/             Logistics        Finance/
                Intelligence                          Administration




                         The Wilson Group 6-04                         41
        EMERGENCY OPERATIONS PLAN

         Emergency Operations Center
       ______________________________

     3.5.1 EOP TEMPLATE: COMMAND STAFF
           Manages & coordinates emergency response

                SAFETY OFFICER (RISK MANAGER)
  Ensures all emergency response operations conducted in safe manner


                           SECURITY OFFICER:
Provides security for all facilities. Controls personnel access to facilities in
   accordance with policies established by the EOC Director.



                         The Wilson Group 6-04                            42
OPERATIONAL AREA: Funnels Information & Access for Mutual Aid
 _______________________________________________

                    FEDERAL
                     FBI, FEMA                     STATE
                                                   REGION
                                                    EOC

City EOCs
                                                               CLINICS

                            Operational
  Private                    Area EOC                              Clinic Field
  Sector
 Vendors                                                              Sites



 Community                                                        Hospitals
  at Large
                                                         Transport
              Special
                                 Fire Depts.           Provider EOCs
              Districts
                           The Wilson Group 6-04                           43
       COMMUNICATION & INFORMATION FLOW
___________________________________________________
                                                                City EOCs

   Staging Areas                                                  CLINICS
                           HEALTH CARE    MEDICAL
                                         OPERATIONS
     Hospitals                                                      * Federal/State/Region
                                                                      OES/EMSA
  Ambulances                         EOC                              * Mutual Aid
                               OPERATIONAL AREA                         Counties
                                   (County)

   Fire                                                                Special Districts

    Police
                                                                       Private Vendors
          Schools
                                                                Nursing Facilities
               Utilities
                                                             Community Resources/
             Red Cross
                                                             General Population
                                     The Wilson Group 6-04                            44
         CLINIC EOC ACTIVATION EVOLUTION
     _____________________________________
                                                       Operations
                    EOC DIRECTOR/IM                    Logistics
                                                       Planning
                                                       Finance
ERT Deployment

                                 CLINIC
                            EOC ACTIVATION




   Alert/Notification ERT                    ERT Mobilization
                               The Wilson Group 6-04                45
    EOC PLANNING: Health Care Situation Analysis


                                            HOSPITALS/
                                            CLINICS
                                            •   ___________     TRANSPORT
                  EVACUATION
                                            •   ___________     PROVIDERS
                    AREAS
                                            •   ___________         •   ___________
                      •   ___________
                                            •   ___________         •   ___________
                      •   ___________
                                                                    •   ___________
                      •   ___________
    FBI                                                             •   ___________   STAGING AREAS
                      •   ___________
INSTRUCTION
•   ___________                                                                        •   ___________
•   ___________                                                                        •   ___________
•   ___________                                                                        •   ___________
•   ___________                                                                        •   ___________
                                                                RED CROSS
                  MUTUAL AID                                    SHELTERS
                  RESOURCE                                      •       ___________
                  REQUESTS                                      •       ___________
                  •       ___________
                                             PRESS
                                            RELEASES            •       ___________
                  •       ___________                           •       ___________
                  •       ___________       •   ___________
                  •       ___________       •   ___________
                                            •   ___________
                                            •   ___________


                                        The Wilson Group 6-04                                      46
               VISUALIZE INFORMATION PATH


             State Emergency Operations Center (EOC)

                            Regional EOC

                        Operational Area EOC

                        Local Jurisdiction EOC

                              Clinic EOC

Operations   Planning      Command Management/       Logistics   Finance
                              IM /EOC Director


                           Command Posts
                             The Wilson Group 6-04                         47
III. USING CLINIC TOOLS & TEMPLATES
                 _____________________

         EMERGENCY PREPAREDNESS

        BUILDING A FOUNDATION
__________________________________

      EFFECTIVE RESPONSE & RECOVERY


                               The 6-04
                    The Wilson Group Wilson Group & Global Vision Consortium
                                                                           48
             PREFACE: HOW TO USE THIS TEMPLATE


PURPOSE –
• Assist clinics to develop & maintain emergency management programs to guide
  their response to all emergencies

•   “Fill-in-the-blank format”

•   Includes planning language, procedure, policies, & forms

•   Tools can provide a “jump-start”


•   Provides useful resources to refine or extend program; Builds on capability



                                   The Wilson Group 6-04                          49
    PREFACE: HOW TO USE TEMPLATE


      Template emphasizes coordination with government emergency
     management.
_______________________________________________

•    Clinics to coordinate preparedness & response to emergencies with
     MEDICAL/HEALTH OPERATIONAL AREA COORDINATOR

•    Contact information for local officials

•    Standard emergency management system (SEMS) concepts




                                      The Wilson Group 6-04              50
    PREFACE: HOW TO USE TEMPLATE


TEMPLATE REQUIRES ACTIVE IMPLEMENTATION EFFORT
_______________________________________________

•    Read template

•    Appoint EMERGENCY PREPAREDNESS COMMITTEE

•    Set priorities & create work plan

•    Recognize importance of training, drills & update plan information




                                     The Wilson Group 6-04                51
               PREFACE: HOW TO USE THIS TEMPLATE


    REGULATORY & ACCREDITATION REQUIREMENTS
     ________________________________
•   Developers of template took into account environment of care Standards of
    Joint Commission on accreditation of healthcare organizations.

•   However, use of template does not guarantee that plans & programs based
    upon it will meet JCAHO or government regulatory requirements for clinic
    emergency preparedness.




                                The Wilson Group 6-04                           52
         PREFACE: HOW TO USE THIS TEMPLATE
       ______________________________

•   Specifically, we recommend that clinic leadership initiate development of
    their emergency management program.

     – Read this template

     – Appoint an EMERGENCY PREPAREDNESS COMMITTEE to manage
       development of their emergency program

     – Set priorities & create work plan for developing plans & preparing staff

     – Recognize importance of training, drills, & keeping plan info. up-to-date

     – Clinic need to work with consortia to develop program


                                 The Wilson Group 6-04                             53
           PREFACE: HOW TO USE THIS TEMPLATE


                    TERMINOLOGY

Given diversity of clinic community roles & organization, it was not possible to develop
a single template that would apply completely to organizational, operational &
environment of every clinic.


CLINIC: Full Range of Non-profit Community Clinics, Free Clinics, & Heath Centers

CLINIC CONSORTIA: County Based or Regional Association of Clinics




                                   The Wilson Group 6-04                          54
                          EOP TEMPLATE:
                 “UMBRELLA” BASIC PLAN
  ___________________________________
• Used Before, During & After Disasters

• Easy to Use; Readable                            A.   INTRODUCTION
                                                   B.   MITIGATION
                                                   C.   PREPAREDNESS
• Answers Questions:                               D.   RESPONSE
   – Who should use plan?                          E.   RECOVERY
   – When should EOP be used?                      F.   APPENDICES
   – Why should EOP be used?




                           The Wilson Group 6-04                       55
                                    EOP TEMPLATE:
                     INTRODUCTION - POLICY
_________________________
•   Clinic able to respond to disaster, suspected case of bio-terrorism or other
    emergency that protects health & safety of patients, visitors, staff, &
    coordinated with community-wide response to large scale disaster.

•   All employees know & prepared to fulfill duties & responsibilities; team effort to
    provide best possible emergency care in any situation.

•   Each supervisor - each level of organization will ensure employees aware of
    responsibilities.

•   Clinic will work – in close coordination with civil authorities & health care
    providers to ensure community-wide coordinated response to disasters.



                                     The Wilson Group 6-04                          56
                                   EOP TEMPLATE:
                    INTRODUCTION - SCOPE
_____________________________
 •   Within plan, DISASTER - any emergency event which overwhelms or threatens to
     overwhelm routine capabilities of Clinic

 •   ALL-HAZARDS EOP - emergency management program designed to respond to
     natural & man-made disasters.

 •   Plan describes POLICIES & PROCEDURES - to mitigate, prepare for, respond to,
     & recover from emergencies.

 ·   CCR Title 22: Disaster plan complies with California Code of Regulations, Title
     22, Division 5, Section 78423 Disaster Plan.


 · JCAHO: Development / implementation of plan complies with sections of JCAHO
   Environment of Care standards related to emergency preparedness. Refer to
   Appendix A for checklist of JCAHO requirements.
                                    The Wilson Group 6-04                          57
                        EOP TEMPLATE: 1.1
                          MITIGATION

•   Clinic - undertake HAZARD MITIGATION activities to lesson severity & impact
    of potential emergency.

•   Mitigation begins to identify potential emergencies that affect organization’s
    operations or demand for services, followed by implementing strategy that
    supports perceived areas of vulnerability within organization.

•   During mitigation phase, Director & staff will identify specific internal &
    external hazards & take steps to reduce level of threat they pose by
    mitigating hazards or reducing their potential impact on clinic.




                                  The Wilson Group 6-04                           58
                         EOP TEMPLATE

                I. HAZARD MITIGATION
 ______________________________
• Clinic will conduct survey of facilities at least annually or
  following disaster that damaged clinic facility; complete
  structural / non-structural hazard mitigation checklist in
  APPENDIX D.3

• Based on results of hazards assessment, clinic will establish a
  plan & priorities for mitigating structural & non-structural hazards




                              The Wilson Group 6-04                  59
                    EOP TEMPLATE: MITIGATION

        1.2 HAZARD VULNERABILITY ANALYSIS

• Clinic will conduct hazard vulnerability analysis to identify
  opportunities to minimize losses in disaster focusing on
  emergencies that may occur within facility as well as external to
  facility in surrounding community.

• Tools for conducting vulnerability analysis are provided in
  APPENDIX D.

• Clinic will re-visit hazard vulnerability assessment yearly to
  address new concerns & challenges.


                            The Wilson Group 6-04                  60
                            EOP TEMPLATE: MITIGATION - 1.2 Refers to D.1


                            HAZARD VULNERABILITY ANALYSIS
                                            Sample: Human Events
     EVENT                  PROBABILITY                               RISK                                      PREPAREDNESS          TOTAL
       \
                     High   Med     Low   None    Life     Health/     High      Moderate      Low       Poor       Fair       Good
                                                 Threat    Safety    Disruptio   Disruptio   Disruptio
                                                                         n           n           n

    SCOREY            3      2       1     0       5         4          3           2           1         3          2          1

                                                       HUMAN EVENTS
Mass Casualty
Incident (Trauma)

Mass Casualty
Incident (medical)

Mass Casualty
Incident
(HAZMAT)

Hazmat Exposure,
External

Terrorism,
Chemical

Terrorism,
Biological

VIP Situation

Infant Abduction

Hostage Situation

Civil Disturbance

Labor Action

Forensic
Admission

Bomb Threat

                                                       The Wilson Group 6-04                                                            61
               EOP TEMPLATE: MITIGATION
   HAZARD VULNERABILITY ANALYSIS PROCESS

CATEGORY       Issues (not limited to these)       • Multiply ratings for
                                                     each event in area of
PROBABILITY    - Known risk                          probability, risk &
               - Historical data                     preparedness.
               - Manufacturer/vendor statistics
                                                   • Total values, in
RISK           - Threat to life and/or health        descending order, will
               - Disruption of services              represent the events
               - Damage/failure possibilities        most in need of
               - Loss of community trus              organization focus &
                                                     resources for
               - Financial impact
                                                     emergency planning.
               - Legal issues
PREPAREDNESS   - Status of current plans           • Determine value below
                                                     which no action is
               - Training status
                                                     necessary.
               - Insurance
               - Availability of back-up systems   • Acceptance of risk is
               - Community resources                 at discretion of
                                                     organization.
                        The Wilson Group 6-04                           62
            EOP TEMPLATE: MITIGATION -1.2 Refers to D.1

                       THE WORKSHEETS


Worksheet 1:             HVA Site Tool (3 pages)
                         Used by most clinic facilities for California region.
Worksheet 2:             Could be used in other states, depending upon
                         geographical or geological area.




Note:   Joint Commission (JCAHO) says that you do not have to
        prepare for an event that will not have an effect upon your
        facility.



                             The Wilson Group 6-04                        63
EOP TEMPLATE: MITIGATION -1.2 Refers to Appendix D.2


                1. Is there an updated disaster plan in the department?
 Emergency
 Preparedness
 Management     2. Has a non-fire related emergency drill been performed in the
                past six months?




                3. Is staff aware of at least three different types of potential non-
                fire emergencies and their role in eliminating or reducing the risk of
                patients, staff and property?




                4. Is staff aware of the primary and secondary exits from facility?




                        The Wilson Group 6-04                                            64
         1. 2 Refers to Appendix D.2

              1. Are doors functioning & locked as appropriate?
SECURITY
MANAGEMENT
              2. Are medical records centrally located and accessible ONLY to
              authorized personnel?




              3. Are alarms functioning, tested, and maintained in accordance
              with manufacturer's specifications?




              4. Are systems/mechanisms in place to quickly notify officials or
              other staff quickly in the event of a security related problem?




                      The Wilson Group 6-04                                       65
EOP TEMPLATE: MITIGATION - 1. 2 Refers to Appendix D.2

                    1. Is all staff utilizing Universal Precautions (i.e. utilizing
    INFECTION       appropriate PPE, handwashing, etc.) in the performance of their
    CONTROL         job duties?
    MONITORING
    ISSUES
                    2. Are cleaning solutions secured, mixed, & utilized appropriately
                    throughout facility?




                    3. Are potentially "infectious patients" aggressively identified &
                    processed in manner which would minimize risk of infection of staff
                    & other patients?




                    4. Can staff intelligently describe their role in infection control
                    within organization?




                             The Wilson Group 6-04                                        66
        EOP TEMPLATE: MITIGATION - 1. 2 Refers to Appendix D.2
                    1. Is there a unique inventory of all medical equipment in facility?
MEDICAL EQUIPMENT
MANAGEMENT
                    2. Is all equipment evaluated & prioritized (Form EC 1.8) prior to use?




                    3. Has all equipment been tested/maintained according to manufacturer's specifications?




                    4. Are maintenance records complete, are they capable of tracking the maintenance
                    history of a particular piece of equipment, & do they record the results of both electrical
                    safety as well as calibration, as appropriate?




                    5. Are systems/mechanisms in place to respond appropriately to medical equipment
                    failure?

                                      The Wilson Group 6-04                                                       67
        EOP TEMPLATE: MITIGATION - 1. 2 Refers to Appendix D.2


                     1. Are lights, emergency lights, & power plugs operational & in working order?
UTILITY MANAGEMENT

                     2. Does water/sewage system appear to be working properly & has water quality been
                     tested within past year?



                     3. Is telephone system operational?



                     4. Has HVAC system been inspected in accordance with manufacturers specifications &
                     have filters been checked quarterly?




                     5. Are fire suppression (sprinkler) systems checked at least once a year, or as appropriate
                     by a qualified individual?



                     6. Are shut-offs for all utility systems clearly marked, & accessible for all staff in the event of
                     an emergency?



                     7. Are systems/mechanisms in place to respond in the event of a failure of any utility
                     system?
                                    The Wilson Group 6-04                                                  68
                         EOP TEMPLATE: MITIGATION


                        1.4 RISK ASSESSMENT
           _______________________
•   Hazard Vulnerability analysis will assess likelihood of disasters & their likely
    severity.

•   Clinic will identify hazards that could not be eliminated & determine their
    likelihood of occurrence & severity of their consequences.

•   Assessment of remaining risks will influence emergency response roles
    clinic adopts for itself & preparation required to meet roles.




                                  The Wilson Group 6-04                            69
                          EOP TEMPLATE: MITIGATION
                     1.5 INSURANCE COVERAGE
         ________________________________
•   Chief Financial Officer of clinic will meet with insurance carriers to review all
    policies & understand facility’s coverage for relocation to another site, loss of
    supplies & equipment, & structural & nonstructural damage to facility.

•   Determine value of insurance for clinic.

•   CFO will assess clinic coverage for floods or earthquakes.

•   If coverage is absent or inadequate, clinic will evaluate if it is financially
    sound to acquire it.

•   Clinics located in special flood hazard areas must have flood insurance to be
    eligible for assistance.


                                   The Wilson Group 6-04                             70
                              EOP TEMPLATE: MITIGATION


     1.6 CLINIC EMERGENCY RESPONSE ROLES

Based on findings of risk assessment, clinic will take following steps to define disaster
response roles for which it should prepare:

     – Assess pre-disaster medical care environment & role clinic performs in providing
       health services

     – Assess clinic resources including availability of staff to respond & ability of clinic to
       survive intact.

     – Discuss findings with MEDICAL & HEALTH OPERATIONAL HEALTH COORDINATOR

     – Obtain community input

     – Obtain input from clinic staff especially medical & nursing directors, safety officer, &
       Chief Operating Officer

     – Present recommendations to Board of Directors for ratification                          71
                                         The Wilson Group 6-04
                            EOP TEMPLATE: MITIGATION

          1.6 CLINIC EMERGENCY RESPONSE ROLES
•   Clinic may play variety of roles in responding to disasters including:
     – Providing emergency medical care,
     – Providing temporary shelter & expanding primary care services to meet
        increased community needs created by damage to other health facilities

•   Clinic may provide mental health services to disaster victims & serve as conduit for
    information dissemination to affected communities

•   Refer to APPENDIX E for list of potential roles & planning & preparedness
    requirements for meeting those roles

•   As part of mitigation program, clinic will identify response roles it will prepare to
    perform following a disaster

•   Decision will involve input from clinic management & staff, clinic Board of Directors,
    community & government emergency officials
                                    The Wilson Group 6-04                           72
           EOP TEMPLATE:

       Application of Concepts
                 OVERVIEW
TABLE OF SECTIONS:

 Introduction
 1. Mitigation

2. PREPAREDNESS

 3. Response
 4. Recovery
 5. Appendices

                 The Wilson Group 6-04   73
              EOP TEMPLATE: PREPAREDNESS



             EMERGENCY PREPAREDNESS
                    Rationale
______________________________
STAFF & PATIENT SAFETY

         COMMUNITY & PATIENT CARE RESPONSIBILITY

              LICENSING & ACCREDITATION MANDATES

                         BUSINESS IMPERATIVE




                         The Wilson Group 6-04     74
                         EOP TEMPLATE: PREPAREDNESS

                              2. 1 INTRODUCTION

•   Preparedness activities build organization capacity to manage effects of
    emergencies should one occur.

•   During this phase, clinic Director, EPC & staff will develop operational capabilities
    & improve effectiveness of clinic’s response to emergencies.

•   Specifically, EPC will:

     • Develop/update emergency plans including Emergency Operations Plan
     • Develop & update agreements with other community medical providers & with
       civil authorities
     • Train emergency response personnel
     • Conduct drills & exercises
                                    The Wilson Group 6-04                            75
             EOP TEMPLATE: PREPAREDNESS

______________________________________
 2.2 EMERGENCY OPERATIONS PLAN

      EOP is an “all hazards” plan that will guide staff to
      provide for an efficient systematic response to any
      type of disaster.




                      The Wilson Group 6-04               76
                      EOP TEMPLATE: PREPAREDNESS


                  2.4.6 ACQUIRING RESOURCES

•   Clinic will develop procedures for augmenting supplies, equipment & personnel
    from variety of sources

•   Prior agreements with vendors for re-supply

•   Stockpiles of medical supplies

•   Operational Area assistance to clinics

•   From other clinics, hospital or other health providers

•   Consortium coordinated clinic assistance to clinics

                                 The Wilson Group 6-04                       77
                      EOP TEMPLATE: PREPAREDNESS
                          2.4
        INTEGRATION WITH COMMUNITY-WIDE RESPONSE

Clinic will notify civil authorities of emergency impacting clinic; coordinate response to
community-wide disasters with medical & health response of Operational Area. See
APPENDIX J.3 – disaster contacts - agencies & individuals

2.4.1      COORDINATION WITH GOVERNMENT RESPONSE AGENCIES
    Clinic will ensure response - coordinated with decisions & actions of civil authorities
    & medical care agencies involved.

   To ensure coordination, clinic staff will:

   A.     Meet with Operational Area officials to define clinic’s role in emergency
          response
          • Determine which response roles - expected by officials & which are beyond
            system’s response needs or clinic’s response capabilities.
          • See APPENDIX E – clinic response roles / responsibilities for potential clinic
            roles.
                                     The Wilson Group 6-04                                78
                    EOP TEMPLATE: PREPAREDNESS
2.4
INTEGRATION WITH COMMUNITY-WIDE RESPONSE

   b.     Participate in planning, training & exercises sponsored by medical response
          agencies.

    c.    Develop reporting & communications procedures to ensure integration with
          Operational Area response.

   d.     Define procedures for requesting & obtaining medical resources & for evacuating /
          transporting patients.



NOTE: In some area, clinic consortium will coordinate completion of these tasks while in
   others, clinics will be responsible for taking initiative in completing these tasks.




                                         The Wilson Group 6-04                                79
                      EOP TEMPLATE: PREPAREDNESS

                           2.4 COORDINATION

OPTIONS FOR MUTUAL ASSISTANCE

•   Information Sharing

•   Referral / diversion of patients to nearby clinics

•   Provision of space & support

•   Provision of medical supply, pharmaceutical & clinical/non-clinical staff support

•   Examples: referral /diversion of patients to nearby hospitals



                                   The Wilson Group 6-04                         80
                           EOP TEMPLATE: PREPAREDNESS


                                2.4.3 COORDINATION

2.4.3.2             LIMITATIONS

    During area-wide disaster, patient transfers & access to ambulances may need to be
    coordinated through medical/health authorities of operational area, overriding other
    agreements.

Developing arrangements for receipt / referral of disaster victims requires
planning:

•   Alert & Notification
•   Sharing of medical information
•   Patient Tracking
•   Contingencies that impact ability of either party to meet terms of agreement

                                      The Wilson Group 6-04                                81
                    EOP TEMPLATE: PREPAREDNESS

          2.4.4     RELATIONSHIP TO CLINIC CONSORTIUM

Clinic & Clinic Consortium Will Define Emergency Response Relationship

In PREPAREDNESS PHASE, Consortium role could include:

•   Resource acquisition including grant funding, group purchasing & shared equipment

•   Training & technical assistance

•   Coordinated planning

•   Exercise coordination

In RESPONSE/ RECOVERY PHASES, Consortium role could include:

•   Information gathering & dissemination to other clinics or 0perational Area

•   Resource acquisition



                                         The Wilson Group 6-04                          82
                    EOP TEMPLATE: PREPAREDNESS

2.4.4 RELATIONSHIP TO CLINIC CONSORTIUM

–     Public Information

–     Technical Assistance

–     Financial Recovery Assistance

Although clinic consortia- not expected to play central operational role in coordinating
disaster response of clinics, they can provide services including:

          Nature of emergency

          Impact of emergency on clinic operations

          Current operational status of clinic

          When clinic expects to become fully operational

          Clinic resource needs


                                     The Wilson Group 6-04                                 83
               EOP TEMPLATE: PREPAREDNESS

2.4.4 RELATIONSHIP TO CLINIC CONSORTIUM
____________________________________________

 C.   Clinic reporting to clinic consortium does not take place of
 reporting to medical / health authorities of Operational Area,
 which should occur first if operational area EOC is open.



 D.  Clinic reporting to clinic consortium does not necessarily
 constitute a request for resources or other assistance.




                          The Wilson Group 6-04                      84
                       EOP TEMPLATE: PREPAREDNESS
          2.5.1 CLINIC DIRECTOR RESPONSIBILITIES
        ___________________________________
•   Ensures program constantly in state of readiness


•   Provides guidance & policy direction response and recovery


•   Main roles:
     – Acts as bridge to outside world
     – Disseminates information
     – Acts as spokesperson


•   Activates the EOP by assigning the IM / EOC Director




                                  The Wilson Group 6-04          85
                        EOP TEMPLATE: PREPAREDNESS

                       ROLES & RESPONIBILITIES
            ______________________________

• 2.5.1 CLINIC DIRECTOR

  –    is responsible, directly or through delegation, for development of EOP & for directing
      response to emergencies

  – Execute development & implementation of disaster plan

  – Assign staff duties & responsibilities based on job action sheets. See APPENDIX.

  – Activate clinic’s emergency response

  – Develop criteria for & direct evacuation of staff, patients, & visitors

  – Ensure continuity of care & maintenance of medical management of all patients in care of
    clinic during a disaster.
                                      The Wilson Group 6-04                               86
                          EOP TEMPLATE: PREPAREDNESS

                          2.5.2 MEDICAL DIRECTOR
    ________________________________________
Directly or through delegation, will have following emergency responsibilities:

•   Serves as leader co-leader of ERT

•   Assigns clinical staff to medical response roles (triage, treatment, decontamination)

•   Provides clinicians with updates from CDC & Health Department on standards for
    detection diagnosis, & treatment of chemical & bio-terrorism agents


•   Contacts local health department to determine local system for bio-terrorism updates.


•   Monitors <name of local system> for updates.

•   Determines clinical staffing needs in cooperation with the Nursing Director.
                                        The Wilson Group 6-04                               87
                       EOP TEMPLATE: PREPAREDNESS

                     2.5.3 - NURSING DIRECTOR

May be assigned following roles:

•   Monitors for Bio-Terrorism

•   Provides clinicians with updates from CDC & NHD of standards or
    detection,diagnosis, & treatment of chemical & Bio-Terrorism agents

•   Determines clinical staffing needs in cooperation with Medical Director

•   Performs other duties delegated by Medical Director or IM consistent with
    training & scope of practice



                                   The Wilson Group 6-04                        88
                  EOP TEMPLATE: PREPAREDNESS


                   2.5.5 ALL CLINIC STAFF
TAKE FOLLOWING STEPS TO FACILITATE RESPONSE TO CLINIC
  EMERGENCIES BY ITS STAFF WHEN THEIR HOMES & FAMILIES MAY
  BE IMPACTED:

•   PROMOTE STAFF HOME EMERGENCY PREPAREDNESS (See Appendix I).

•   IDENTIFY CHILDCARE RESOURCES LIKELY TO REMAIN OPEN FOLLOWING A
    DISASTER




                            The Wilson Group 6-04                    89
                        EOP TEMPLATE: PREPAREDNESS


                         2.5.5 - ALL CLINIC STAFF

All Clinic staff shall:

•   Familiarize themselves with evacuation procedures & routes for their areas. See
    APPENDIX H & 1.1

•   Become familiar with emergency response procedures for fire, HAZMAT & other
    emergencies. See APPENDIX H & Section 3.14

•   Understand role & responsibility in clinic plans for response & recovery

•   Participate in training/exercises

•   Make suggestions on how to improve planning

•   Prepare family & home for disasters

                                        The Wilson Group 6-04                         90
                   EOP TEMPLATE: PREPAREDNESS
                      2.5.5 Refers to APPENDIX F.3


            EMERGENCY RESPONSE/RECOVERY TEAM
                         JOB ACTION SHEETS
LIST OF POSITIONS
• Clinic Director
• Incident Manager
• Public Information Officer
• Legal Counsel
• Liaisons
• Safety Officer
• Security Officer
• Operations Section Chief
• Planning & Intelligence Section Chief
• Logistics Section
• Finance & Administration Section
                              The Wilson Group 6-04   91
      EOP TEMPLATE: PREPAREDNESS 2.5.5 Refers to Appendix F.3

                     EOC JOB ACTION SHEETS
                               CLINIC DIRECTOR


Line of Authority
• Line of authority flows from Clinic Executive Director & then to Incident
   Manager, & finally to the Section Chiefs in the EOC.

Responsibility and Duties
• Clinic Executive Director & EOC Incident Manager should confer during major
   emergencies, providing guidance & policy direction for emergency response &
   recovery strategy assessment, including:
          Identifying operations still at risk
          Establishing clinic operations restoration priorities
          Authorizing expenditure of funds for emergency acquisitions & for additional
          personnel expenditures, as needed


                                  The Wilson Group 6-04                                  92
                         EOP TEMPLATE: PREPAREDNESS

      2.6 INITIAL COMMUNICATIONS & NOTIFICATIONS
       ____________________________________

•   Clinic will compile/maintain internal contact list for staff:

•   Name, position title, home phone, cell, pager, & preferred method of contact
    during off hours. Refer to APPENDIX

•   List will be kept off-site & on key employees

•   List should be treated as sensitive because of personal contact info.

•   Clinic should distribute laminated wallet-sized cards with contact info. for key
    staff.

•   Clinic will compile/maintain external contact list. Refer to APPENDIX (utilities,
    repair) & (hospitals/clinics,media)
                                      The Wilson Group 6-04                             93
                       EOP TEMPLATE: PREPAREDNESS


                  2.6.2 EXTERNAL NOTIFICATION

Clinic will compile & maintain external contact list of phone numbers of key
vendors, stakeholders, resources, & emergency response agencies.

•   APPENDIX J.2___ lists routine & emergency contact numbers for basic
    support services for clinic operations (e.g., utilities, repair services, etc.)

•   APPENDIX J.3___ lists contact information for use - response to disasters
    (e.g., government response entities, nearby hospitals & clinics, media, etc.)




                                    The Wilson Group 6-04                             94
                       EOP TEMPLATE: PREPAREDNESS
                         2.6.2 Refers to APPENDIX J.2
                         CONTACT LISTS:
         VENDORS / FUNDING SOURCES / COMMUNITY LIAISONS

•   Clinic Consortium
•   Electricity
•   EMS Provider
•   Fire Service
•   Gas or Propane
•   Information Technology Support
•   Law Enforcement
•   Medical Supply and Equipment
     –   Vendor
     –   Repair
     –   Maintenance
     –   Telephone
•   Equipment Provider
•   Equipment Repair
•   Service Provider
                               The Wilson Group 6-04      95
                       EOP TEMPLATE: PREPAREDNESS
                       2.6.2 Refers to APPENDIX J.3:

           CONTACT LIST – DISASTER RESPONSE OFFICIALS
•   County EOC
•   Med/Health Op Area Coordinator
•   Division of Epidemiology: Bio-terrorism Emergency Number
•   CDC Emergency Response Office
•   Nearest Hospital Emergency Department
•   Nearest Clinic / Medical Group
•   Local EMS Agency
•   Health Department (general)
•   Name of County> County Medical Society
•   Name of County> Office of Emergency Services Director
•   Amateur Radio
•   Media – Television
•   Media – Radio
•   Media – Newspaper              The Wilson Group 6-04       96
                        EOP TEMPLATE: PREPAREDNESS

                 2.6.3 PRIMARY COMMUNICATIONS

•   Refer to APPENDIX K.1 for list of communications resources available to clinic.

•   Primary means - local telephone

•   If telephone fails, clinic staff will notify provider by whatever means available
    including telephones in another area, cell phones, messenger, E-Mail, or pay
    phones

•   Clinic will keep change for pay phones in its disaster supplies

•   Clinic has installed standard telephone jacks that bypass electronic phone
    system.

•   Jacks - used for fax machines & for telephones that do not require electricity to
    operate.
                                    The Wilson Group 6-04                               97
                        EOP TEMPLATE: PREPAREDNESS
                         2.6.3 Refers to APPENDIX K.1:

        COMMUNICATIONS EQUIPMENT INVENTORY
•   Clinic Phone System
•   Fax Machines
•   Analog telephone jacks
•   Analog telephones
•   Cellular telephones
•   Satellite telephones
•   Computer
•   Email
•   Telemedicine
•   Videoconference – camera and video-monitor
•   Radio-based
•   Amateur Radio
•   Handheld radios
•   Other Radios
•   EMS – Ambulance
•   Hospital Status Radio         The Wilson Group 6-04   98
                         EOP TEMPLATE: PREPAREDNESS

      2.6.4 ALTERNATE COMMUNICATIONS METHODS
      _____________________________________
•   In addition to telephone, clinic maintains radio communications equipment.

•   Refer to APPENDIX K.2 for procedures for operating county specific
    radio/communications system.

•   Radio - located in clinic area & used by trained staff.

•   Clinic maintains Amateur Radio System or alternate communication system -
    located in clinic area & used only by trained staff.

•   Clinic maintains Amateur Radio System or alternate communication system -
    located in clinic & agreement with local Amateur Radio group to respond to clinic
    when requested.


                                     The Wilson Group 6-04                        99
                     EOP TEMPLATE: PREPAREDNESS

      2.6.4 ALTERNATE COMMUNICATIONS TOOLS
__________________________________________
•   Amateur radios, FAX, Cell Phone, Internet/E-Mail, Public Pay Phones, Voice
    Messaging. See APPENDIX for communication resource list.

•   HANDHELD RADIOS (WALKIE-TALKIE) – for internal communications in both
    routine & emergency situations

•   If telephone & radio communications are unavailable, RUNNER will be
    employed to take messages to & from Clinic & appropriate agencies
    rendering assistance.

•   Clinic EOC - provisions for receiving TELEVISION & RADIO broadcasts to
    remain up to date on official GOV. announcements


                                The Wilson Group 6-04                            100
             EOP TEMPLATE: PREPAREDNESS

         2.7.2 ALTERNATE FACILITIES

•   Identify/use existing facilities if possible; Consider creative alternatives

•   Ensure sufficient space & equipment

•   Provide reliable logistic support & services

•   Ensure ability to sustain operations for 30 days

•   Consider pre-positioning assets & resources

•   Ensure appropriate physical security & access controls




                          The Wilson Group 6-04                            101
                          EOP TEMPLATE: PREPAREDNESS

                 2.7.1 CONTINUITY OF OPERATIONS

•   POLICY: Clinic will maintain or restore services to community as rapidly as
    possible following emergency that disrupts services.

•   As soon as safety of patients, visitors, & staff has been assured, clinic will give
    priority to providing or ensuring patient access to medical care.

•   GOALS: Completing following tasks increases likelihood that emergency will not
    disrupt clinic operations, & if disruption occurs, operation can be restored.
     – Protect essential facilities, equipment, records, & assets
     – Reduce or mitigate disruption to operations
     – Identify & designate principals & support staff to e relocated; succession & delegations
       of authority for execution of Plan
     – Facilitate decision-making through establishment of lines of succession & delegation


                                      The Wilson Group 6-04                              102
           EOP TEMPLATE: PREPAREDNESS

             2.7 COOP
___________________________________
             PREPARE
             • Contingency Plan, which addresses short term losses,
               or a
PURPOSE
             • Continuity Plan which addresses long term losses for
               their systems



              Enables Clinic to maintain operation of critical
              functions in event of contingencies, losses,
BENEFITS      disruptions, or disasters




                    The Wilson Group 6-04                        103
                    EOP TEMPLATE: PREPAREDNESS
                               2.7 COOP
                        On-Going Requirements

   Essential Functions – Personnel, Equipment, System and Space Requirements
   Successor Plan, Delegation of Authority, and Team Assignments
   Primary & Secondary Contact Lists
   Primary & Alternate Site Vulnerability Analysis
   Deployment Information – Storage Locations
   Transportation & Alternate Facility Activities; Equipment & Systems
   Emergency Operating Records
   COOP Maintenance Team
   Vendor List




                               The Wilson Group 6-04                     104
                      EOP TEMPLATE: PREPAREDNESS

                 2.8.1 PREPAREDNESS: SURGE

•   Clinic Director, Nursing, &/or Medical Director will review Op Area plans

•   How surge capacity will be increased

•   Patient transportation policies/procedures

•   Procedures for augmenting medical care - Op Area plans for accessing &
    distributing contents of National Pharmaceutical Stockpile

•   Develop surveillance process to provide early indications of potential for
    patient surge that may result from Bio-Terrorism (appointment patterns, walk-
    in clinic utilization, news report, groups of patients ill at same time)


                                 The Wilson Group 6-04                          105
                      EOP TEMPLATE: PREPAREDNESS

    2.8.1.5 SURGE – PATIENT FLOW & SITE PLANNING

•   Periodically review patient flow & identify areas on clinic grounds that can be
    converted to triage sites & patient isolation areas

•   Evaluate appropriateness of use of cafeteria, break rooms & other spaces for
    patient holding or treatment areas

•   Designate sites available for isolating victims of a chemical/bio-terrorist
    attack

•   Ensure triage & isolation sites should have controlled access

•   Store cots, blankets for holding & shelter


                                  The Wilson Group 6-04                           106
                     EOP TEMPLATE: PREPAREDNESS
2.9.2
PHARMACEUTICALS / MEDICAL SUPPLIES / MEDICAL EQUIPMENT

Clinic will determine level of medical supplies & pharmaceuticals to stockpile; will stockpile only
those items likely to use in response or in day-to-day operations. All stored items will be rotated.

Clinic will identify primary & secondary sources of medical supplies & pharmaceuticals; develop
estimates of expected time required for re-supply in disaster environment.


       NATIONAL PHARMACEUTICAL STOCKPILE

NOTE: IN BIO-TERRORIST EVENT, IF MASS QUANTITIES OF PHARMACEUTICALS ARE NEEDED,
  COUNTY WILL REQUEST MOBILIZATION & DELIVERY OF NATIONAL PHARMACEUTICAL
  STOCKPILE THROUGH CA. CDC HAS ESTABLISHED NATIONAL PHARMACEUTICAL
  STOCKPILE (NPS)




                                          The Wilson Group 6-04                                107
                      EOP TEMPLATE: PREPAREDNESS


    2.9.2.3 NATIONAL PHARMACEUTICAL STOCKPILE

•   In Bio-terrorist event, if mass quantities of pharmaceuticals are needed then
    Op Area (Co.) will request mobilization & delivery of National Pharmaceutical
    Stockpile (NPS)

•   CDC has established NPS as repository of antibiotics, chemical antidotes, life
    support med, IV adm., life support meds, IV sets, airway maint.

•   Clinic leadership should be informed of local level plan & what role, if any,
    they might be expected to play in distribution of assets




                                  The Wilson Group 6-04                             108
                         EOP TEMPLATE: PREPAREDNESS
         2.9.2.4 PERSONAL PROTECTIVE EQUIPMENT

•   Clinic will take measures to protect its staff from exposure- infectious agents &
    hazardous materials

•   Clinic will obtain & maintain a minimum of PPE

•   CDC & OSHA have determined that in event of a Bio-Terrorist attack

     – Healthcare workers will have access to & be trained on use of personal protective
       equipment.


     – Licensed medical personnel & support personnel are assigned to respond to care for
       victims of WMD


                                      The Wilson Group 6-04                                109
                     EOP TEMPLATE: PREPAREDNESS

     2.9.2.4 RESPONSE TO BIO-TERRORISM EVENT
•   Suggested PPE for level C:
     – N95 HEPA mask
     – TYVEK Coverall with hood and booties
     – TYVEK booties
     – Face shield
     – Nitrile Gloves
•   Protective equipment is located in ____________, & will be accessed by
    _______________ or ____________ when ______________.




                                 The Wilson Group 6-04                       110
                      EOP TEMPLATE: PREPAREDNESS


                         2.10 Mental Health
•   Clinic Administrator will establish DISASTER MENTAL HEALTH
    COORDINATOR. See APPENDIX M for a checklist of actions for the Mental
    Health Coordinator

•   Develop an internal clinic mental health disaster response plan

•   Serve as member of Emergency Preparedness Committee & ERT

•   Coordinate with local jurisdiction & Operational Area (county) to identify
    community resources & define procedures for implementation




                                  The Wilson Group 6-04                          111
                EOP TEMPLATE: PREPAREDNESS

      2.10.1 MENTAL HEALTH PREPAREDNESS
___________________________________________
  e.  Coordinate local jurisdiction & Operational Area (county) for
  community resources & procedures for access to resources

  f.   Develop & maintain resource list of community mental health
  resources to augment response of clinic’s mental health team. Establish
  MOUs when possible.

  g.   Identify mental health disaster communication needs

  h.   Work with clinic PIO to develop info. (brochures, PSAs, etc.) used in
  response

  i.  Acquire & maintain following resources stored with other disaster
  supplies labeled “Mental Health Supplies”:
   – Contact information for disaster mental health resources updated annually
   – Master copy of one or more brochures with information about typical survivor
     responses to a disaster with Clinic or Mental Health Agency contact phone
                                 The Wilson Group 6-04                         112
     numbers
                          EOP TEMPLATE: PREPAREDNESS
    2.10.1           MENTAL HEALTH PREPAREDNESS

•   A limited amount of brochures for immediate use

•   Culturally appropriate brochures in several languages of clinic’s service populations

•   Basic office supply “go box” with pens, paper clips, tape, note pads available to staff

•   Paper, crayons & other items for children

•   Cell phone or calling cards available for staff’s use

•   Disaster forms to document contacts

•   Copies of local resource directory & agency directory for referrals


                                        The Wilson Group 6-04                                 113
                       EOP TEMPLATE: PREPAREDNESS

                       2.10.2 REFERS TO APPENDIX M –
         MENTAL HEALTH COORDINATOR RESPONSIBILITIES

P
    •   Assume role of Clinic Mental Health Coordinator
R
E
    •   Develop internal Clinic Mental Health Disaster Response Plan
P
A   •   Coordinate with Local Jurisdiction & Operational Area (County)
R
E
    •   Identify mental health disaster communications needs
D
N
    •   Promote mental health clinic preparedness
E
S   •   Promote clinic awareness of importance of mental health prevention /
S       awareness



                                  The Wilson Group 6-04                        114
                    EOP TEMPLATE: PREPAREDNESS
                     2.10.2 REFERS TO APPENDIX M –

           MENTAL HEALTH COORDINATOR CHECKLIST

P    Establish & maintain comprehensive city & county-wide mental
R     health resource list
E
P    Use emergency information management & communications systems
A
R    Develop mental health resource list
E
D    Coordinate with local mental health officials & mental health
N     managers
E
S    Coordinate with mental health facilities to develop disaster
S     preparedness


                                The Wilson Group 6-04                 115
                         EOP TEMPLATE: PREPAREDNESS

         2.9  DISASTER MEDICAL RESOURCES
    _____________________________________________
2.8.1      PERSONNEL

- Clinic will rely on existing staff for response to emergencies.

- MEASURES TO BE TAKEN TO ESTIMATE STAFF AVAILABILITY:

•   Identify clinical staff with conflicting practice commitments

•   Identify staff with distance & other barriers that limit their ability to report to clinic

•   Identify staff likely to be able to respond rapidly to the clinic

•   Clinic will develop roster of bi-lingual staff by language

                                          The Wilson Group 6-04                                  116
                             EOP TEMPLATE: PREPAREDNESS

       2.11 PUBLIC INFORMATION / RISK COMMUNICATIONS

INCIDENT MANAGER will appoint PUBLIC INFORMATION OFFICER (PIO) to coordinate
   release of clinic information internally & externally to media & community.
PIO will ensure development of disaster public information plan to guide clinic information
   disseminaiton & response to media & community inquiries following disasters.
PURPOSE OF PLAN - to ensure information is communicated to communities served by clinic
   to communicate:
•   Information on nature & status of emergency
•   Appropriate actions for protection, seeking health care services & obtaining needed
    information
•   Reducing anxiety among community members
•   Information on status of clinic & its ability to deliver services




                                        The Wilson Group 6-04                             117
                      EOP TEMPLATE: PREPAREDNESS

     2.11 PUBLIC INFORMATION / RISK COMMUNICATIONS


Plan will include provisions for:
COORDINATION WITH OPERATIONAL AREA PUBLIC INFORMATION OFFICER

•   Ensure most up-to-date information & to ensure consistency of information
    released.
•   Address information needs of clinic’s “publics” when providing information;
    stakeholders include community, patients, staff, volunteers
•   Provisions for employee meetings, internal informational publications, press
    releases & other programs intended to disseminate accurate information
    regarding impact & deal with misinformation.




                                 The Wilson Group 6-04                    118
                EOP TEMPLATE: PREPAREDNESS

2.11 PUBLIC INFORMATION / RISK COMMUNICATIONS


Clinic will incorporate disaster preparedness information into normal
communications & education program for staff & patients including:

•   Home & family preparedness. See appendix I for guidelines

•   Information on clinic emergency preparedness activities

•   Information dissemination channels include newsletters,
    pamphlets, health education & in-service education classes &
    internet postings




                           The Wilson Group 6-04                    119
             EOP TEMPLATE: PREPAREDNESS

                 2.12 Refers to Appendix G
              PURPOSE OF TRAINING


Training for members of the ERT ensures:
   – Know role & responsibilities;
   – Possess skills & knowledge needed to perform
     respective functional responsibilities; &
   – Understand disaster management processes to
     achieve effective coordination / communications




                      The Wilson Group 6-04            120
                         EOP TEMPLATE: PREPAREDNESS

                    2.12.1.1 EMPLOYEE ORIENTATION


•   Instructed how to assist patients & staff in evacuation of premises.

•   Instructed in location & use of oxygen (licensed staff)

•   Shown location & use of medical emergency equipment (medical staff & staff trained
    on AED).

•   Instructed on emergency codes used in clinic, how called & initial actions. (See
    APPENDIX H.2 – emergency code examples).

•   Instructed on actions to be taken during fire & other emergency drills.

•   Annual training & updates on emergency preparedness, including elements of plan




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                    EOP TEMPLATE: PREPAREDNESS

         2.12.1.2 CLINICIAN BIO-TERRORISM TRAINING

Medical & Nursing staff will receive training on procedures to treat & respond to
patients infected - Bio-terrorism agent.

        Recognition of potential epidemic or bio-terrorism events

        Information about most likely agents, including possible behavioral
        responses of patients

        Infection control practices

        Use of personal protective equipment

        Reporting patient management

        Behavioral responses of patients to biological & chemical agents




                                The Wilson Group 6-04                          122
                 EOP TEMPLATE: PREPAREDNESS

        2.12.1.2 CLINICIAN BIO-TERRORISM TRAINING

B.   Staff training will include:
     - Roles & responsibilities in bio-terrorism event;
     - Information & skills required to perform their assigned duties
     during bio-terrorism event;
     - Awareness of backup communications systems used in bio-
     terrorism event;
     - Location / how to obtain supplies during bio-terrorism event.

C.   Staff & physicians will receive updates as new information
     becomes available.

D.   Mental Health Team training




                            The Wilson Group 6-04                       123
                        EOP TEMPLATE: PREPAREDNESS

                        2.12.2 DRILLS & EXERCISES


2.12.2.2 Exercises should include response issues in scenarios:

•   Clinic evacuation

•   Bio-terrorism

•   Mental health response

•   Coordination with government emergency responders

•   Continuity of Operations

•   Expanding clinic surge capacity




                               The Wilson Group 6-04              124
                         EOP TEMPLATE: PREPAREDNESS
                             2.12 Refers to Appendix G
           TEMPLATE PROVIDES TRAINING & MAINTENANCE
ITEM                 YEAR:          1             2       3   4   5
Redesign Emergency Plan
Redesign Primary EOC
Redesign Alternate EOC
Redesign EOC Staffing
Redesign Comm. Systems
Redesign Budget Process
Perform Off-Hours Exercise
Perform Weekend Exercise
Develop New MOUs
Develop JPA, if needed
Audit Emergency Programs
Revise 5-Year Plan
Revise Annual Plan
                                  The Wilson Group 6-04           125
                           EOP TEMPLATE: RESPONSE


3.1 Introduction
    Clinic mobilizes resources & takes actions required to manage response to
    disasters.

3.2 Response Priorities
    Clinic has established following disaster response priorities:

    •   Ensure life safety - protection of life & provide care for injured patients, staff
        and visitors
    •   Contain hazards to facilitate protection of life.
    •   Protect critical infrastructure, facilities, vital records & other data
    •   Resume delivery of patient care
    •   Support community response
    •   Restore essential services/utilities
    •   Provide Crisis Public Information




                                     The Wilson Group 6-04                              126
                     EOP TEMPLATE: RESPONSE
3.12 Refers to APPENDIX M: MENTAL HEALTH COORDINATOR CHECKLIST
         Check only those actions appropriate to the situation




    CRISIS INTERVENTION ACTIONS for                Date /        Authorized
    EMERGENCY / DISASTER SITUATIONS                Time          Personnel

    TO DO FIRST




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                               EOP TEMPLATE: RESPONSE
         _____________________________________
3.3 ALERT, WARNING & NOTIFICATION
•   After alert from civil authorities & other credible sources, Clinic Director notifies key
    managers; orders updating of phone lists, inspection of protective equipment, supply &
    pharmaceutical caches
•   On nature of warning & potential impact of emergency - Director & Medical Director decides
    to:
     –   evacuate facility;
     –   suspend or curtail clinic operations;
     –   take actions to protect equipment, supplies & records;
     –   move equipment, supplies to secondary sites; backup, secure computer files; &
     –   measures to reduce clinic, staff and patient risk.

3.4 RESPONSE ACTIVATION & INITIAL ACTIONS
•   Plan activated in response to events within clinic or external to it. Any staff member who
    observes incident / condition that may result in emergency should report & call 911.
•   All staff should initiate emergency response actions consistent with procedures outlined in
    APPENDIX. Emergency Response Procedures in COLOR CODED FLIPCHART FORMAT.
•                                      Director Group 6-04
    Plan may be activated by Executive The Wilson or designee ate request of civil authorities.
                                                                                              128
                           EOP TEMPLATE: RESPONSE

3.5.1
• INCIDENT MANAGER oversees command/management function (command at the field level
     & management at all other levels) – function that provides:
      • overall emergency response policy direction,
      • oversight of emergency response planning, operations &
      • coordination of responding clinic staff and organizational units.

•   MANAGEMENT STAFF supporting Incident Manager consists of Public Information Officer,
    Safety Officer & Security Officer. Liaison officers responsible for coordination with other
    agencies, & legal counsel may also be added to management staff.

    The INCIDENT COMMAND SYSTEM has the following characteristics:

    a.     ORGANIZATION FLEXIBILITY – Modular Organization
           Types of activated functions & relationship to one another will depend upon
           size & nature of incident. Only those functional elements required to meet
           current objectives will be activated.

    b.     MANAGEMENT OF PERSONNEL – Hierarchy of Command & Span-of-Control
           Each activated function will have person in charge of it, but a supervisor
           may be in charge of more than one functional element. Every individual will have a
           supervisor.               The Wilson Group 6-04                                        129
                         EOP TEMPLATE: RESPONSE


3.15 External Emergencies
    An EXTERNAL DISASTER is event that occurs in community. Examples include:
   – Earthquakes
   – Floods
   – Fires
   – Hazardous Materials Releases
   – Terrorist Events
   External disaster may directly impact clinic facility & its ability to operate.

   LOCAL VS. WIDESPREAD EMERGENCIES

      LOCAL EMERGENCIES are disasters whose effects are limited toe community or area near
      clinic. In local emergencies, other health facilities & resources will be relatively unaffected
      & remain viable options for sending assistance or receiving patients from disaster area.

      In WIDESPREAD EMERGENCIES, nearby medical resources are likely to be impacted &
      therefore less likely to be able to offer assistance to the clinic. Hospitals may also have
      higher response priority than clinics for re-supply and other response assistance.


                                    The Wilson Group 6-04                                       130
                         EOP TEMPLATE: RESPONSE

3.5.2
• ICS employs four functional sections in its organizational structure:
    1. OPERATIONS
    2. PLANNING
    3. LOGISTICS
    4. FINANCE

   A detailed description of staff & functions is included in APPENDIX

   1.    OPERATIONS – coordinates all operations in support of emergency
         response. Implements Incident Action Plan for a defined
         operational period of response.

   2.    PLANNING & INTELLIGENCE – collects, evaluates & disseminates
         information; develops Incident Action Plan in coordination with other
         functions; performs advanced planning & documents response status.
         See APPENDIX for Action Planning Guidance & Forms.




                                 The Wilson Group 6-04                           131
                    EOP TEMPLATE: RESPONSE

                        3.5.2 RESPONSE
3. LOGISTICS – provides facilities, services, personnel, equipment &
   materials to support response operations.

4. FINANCE & ADMINISTRATION – tracks personnel & other
   resources costs associated with response & recovery; provides
   administrative support to response operations.




                           The Wilson Group 6-04                       132
     EOC: RESPONSE OBJECTIVES
___________________________________


                    Achieve
                     Goal
                   Perform
                   Direction


                Select Strategy


         Establish Incident Objectives


        Understand Policy & Direction

                 The Wilson Group 6-04   133
              EOP TEMPLATE: RESPONSE


             3.5.4 ERT Organization
 ___________________________________

ERT   • Provides expansion of Clinic delegation of authority
      • Ensures coordination/ support
      • ERT includes Clinic staff:
         – Director
         – Chief Deputy Director
         – Division Directors
      • Ensures Policy Directives
      • Allocates critical resources
      • Makes coordinated Director level decisions




                    The Wilson Group 6-04                134
                            EOP TEMPLATE: RESPONSE
                       3.5.2 Refers to Appendix F.3 EOC
                            JOB ACTION SHEETS
                                 CLINIC DIRECTOR
ACTIVATION DUTIES
•   Approve activation of EOP, ERT, & EOC.
•   Have initial briefing with EOC Incident Manager.
•   Review Executive Director’s responsibilities & open log book.
•   Determine where Executive Director will be during recovery, & set up that position.
•   Meet with PIO to:
     – Develop protocols & schedule for news briefings
     – Establish schedule for delivery of Action Plan updates, status reports, & news releases
     – Establish policy on visitor’s access to Clinic during emergency response & recovery

     Develop policy on contacts with Operational Area response actions during disasters while
     emergency response & recovery in progress.

                                     The Wilson Group 6-04                             135
           EOP TEMPLATE: RESPONSE

3.6.3 EOC Director / IM Responsibilities
 ___________________________
 •   Evaluates EOC “Activation Trigger Matrix”
 •   Makes decisions
 •   Ensures staff notification
 •   Directs EOC activation
 •   Contacts key stakeholders
 •   Conducts briefings
 •   Ensures delegation of duties
 •   Ensures external safety, parking, & access
 •   Directs IM / Safety Officer



                  The Wilson Group 6-04           136
                      EOP TEMPLATE: RESPONSE




3.7 MEDICAL CARE
•   Provide safe supervised site for children away from adults.
•   Attempt to contact each child’s family.
•   If contact is not possible, contact Child Protective Services to
    provide temporary custodial supervision until a parent or family
    member is located.




                             The Wilson Group 6-04                     137
                           EOP TEMPLATE: RESPONSE
     ______________________________________
3.5.4
Following examples of potential position assignments of clinic staff to ICS position:

•   INCIDENT MANAGER – Clinic Director, Chief Operating Officer (COO) or Deputy
    Director, Medical Director, Nursing Director

•   OPERATIONS CHIEF – Medical Director, Nursing Director

•   PLANNING / INTELLIGENCE – COO

•   LOGISTICS – Facilities manager, Purchasing manager, Human Resources manager

•   FINANCE / ADMINISTRATION – Chief Financial Officer (CFO) or Finance Director,
    COO
                                   The Wilson Group 6-04                          138
                                EOP TEMPLATE: RESPONSE
                          3.6.2 Refers to APPENDIX L.2:
           Primary & Alternate Clinic EOC / Command Center Locations
                                     (SAMPLE)


PRIMARY EMERGENCY OPERATIONS CENTER / COMMAND         ALTERNATE EMERGENCY OPERATIONS CENTER /
                   CENTER                                        COMMAND CENTER




                                         The Wilson Group 6-04                                  139
                            EOP TEMPLATE: RESPONSE
                           3.6.4 Refers to APPENDIX O


EOC ACTION PLAN
                                                               TIME PREPARED:
 INCIDENT OBJECTIVES                          DATE PREPARED:




OPERATIONAL PERIOD FROM:                      TO:




1. GENERAL OBJECTIVES: (FROM MANAGEMENT SECTION)




                                   The Wilson Group 6-04                        140
                                        EOP TEMPLATE: RESPONSE
                                     3.6.4 Refers to APPENDIX O
                                       24 HOUR ACTION PLAN
FOR REPORTING PERIOD

FROM : ____:____ AM/PM                                   TO: ____:____ AM/PM



        NOTE: ACTIONS ASSIGNED HEREIN SHOULD BEGIN DURING THIS OPERATIONAL PERIOD AND
        UNITS SHOULD REPORT PROGRESS AT THE EOC BRIEFING AT           : __  _ AM/ PM.



        TIME/DATE PREPARED:




                                                          DISTRIBUTION:
       PREPARED BY PLANNING SECTION CHIEF:
                                                          All EOC Sections and Units
                                                          Other




       APPROVED BY EOC DIRECTOR:




                                             The Wilson Group 6-04                      141
                    EOP TEMPLATE: RESPONSE
                     3.12 Refers to Appendix M:
CRISIS INTERVENTION ACTIONS for EMERGENCY / DISASTER SITUATIONS
TO DO FIRST   1    Notify Clinic Director &/or Designee; IM & Public Information Officer



              2    Evaluate needs for EOC command center with logistics support
                   (phone, email access)


              3    Set up mental health briefing station


              4    Dispatch Mental Health Team


              5    Designate meeting place & convenient building for Mental Health
                   Team to whatever extent possible


              6    Assemble Mental Health Team/phone tree, assign roles & duties


              7    Gather information & conduct assessment. Obtain facts: police,
                   hospital, clinic ERT/EOC


              8    Identify most gravely affected patients, staff


              9    Determine need for outside agency resource personnel & notify as
                   appropriate
                                   The Wilson Group 6-04                                   142
                          EOP TEMPLATE: RESPONSE
                   3.14.5 - Decision on Clinic Status


• Executive Director will decide evacuation status for clinic

• Decision return to facility &/or re-open facility for partial or full
  operation depends on assessment of following:

    –   Extent of facility damage / operational status.
    –   Status of utilities (e.g. water, sewer lines, gas and electricity
    –   Presence & status of hazardous materials
    –   Condition of equipment & other resources
    –   Environmental hazards near clinic



                                   The Wilson Group 6-04                    143
                       EOP TEMPLATE: RESPONSE
                 3.14.5.1 - Extended Clinic Closure


• If clinic experiences major damage, loss, etc, Executive Director/CEO
  may suspend clinic operations until conditions change

• If decision is made:
    – Ensure clinic site is secure
    – Notify staff of clinic status & to remain available for work
    – Notify medical authority of Operational Area of its change in status.
    – Notify nearest hospital(s) & clinic(s) of status change
    – Place a sign/explanation on clinic in appropriate languages
    – If safe, station staff at clinic entrance to answer patient questions &
      make referrals
    – Implement business recovery plan




                               The Wilson Group 6-04                        144
                          EOP TEMPLATE: RESPONSE
   ______________________________________
3.15.2 WEAPONS OF MASS DESTRUCTION (WMD)

  Preparations for WMD - chemical, biological, nuclear, radiological, or
  explosives (CBRNE)
  If staff suspects event of (CBRNE) has occurred, they should:

  –   Remain calm & isolate victims to prevent further contamination within facility.
  –   Contact Clinic Nurse Manager immediately.
  –   Secure their own personal protective equipment; wait for instructions.
  –   Comfort victims.
  –   Contact appropriate operational area authorities


                                  The Wilson Group 6-04                          145
                          EOP TEMPLATE: RESPONSE
    ______________________________________


3.15.3.2 BIO-TERRORISM RESPONSE

Clinic response to a bio-terrorism incident may be initiated by Executive
Director or Medical Director due to:

•   Request of local civil authorities.
•   Government official notification of an outbreak within or near the clinic’s
    community.
•   Presentation of patient with a suspected exposure to a bio-terrorist agent.
•   In case of presentation by patient with suspected exposure to bio-terrorist agent,
    Clinic will follow current CDC response guidelines.



                                   The Wilson Group 6-04                         146
                             EOP TEMPLATE: RESPONSE
  ______________________________________

3.15.3.3 POTENTIAL INDICATORS OF A BIO-TERRORISM ATTACK are:
• Groups of people becoming ill around same time.
• Sudden increase of illness in previously healthy individuals.
• Sudden increase in following non-specific illnesses:

   1.     Pneumonia, flu-like illness, or fever with atypical features
   2.     Bleeding disorders
   3.     Unexplained rashes, mucosal or skin irritation, particularly in adults
   4.     Neuromuscular illness, like muscle weakness and paralysis
   5.     Diarrhea
   6.     Simultaneous disease outbreaks in human, animal & bird populations
   7.     Unusual temporal or geographic clustering of illness (for example, patients who attended
          same public event, live in same part of town, etc.)
   Two summary tables of potential biological warfare agents, including signs, symptoms,
   transmission, precautions and treatment, are provided in APPENDIX.


                                        The Wilson Group 6-04                                  147
                            EOP TEMPLATE: RESPONSE
    ______________________________________

3.15.3.1 REPORTING

•   Clinic physicians will report diseases resulting from bio-terrorist agents, like other
    communicable & infectious diseases, to County Department of Epidemiology at
    (phone number).

•   Emergency amendments to the California Code of Regulations (Title 17), effective
    November 5, 2001 (http://www.dhs.ca.gov/regulations) made those diseases that pose
    significant threat, such as agents of biological terrorism, immediately reportable by
    health care providers to local health department.




                                     The Wilson Group 6-04                                   148
                           EOP TEMPLATE: RESPONSE
    ______________________________________

3.15.3.7 MASS PROPHYLAXIS

•   Medical providers from clinics throughout county could be called to volunteer to
    distribute medication or provide vaccines in response to large-scale attack.

•   Under this scenario, mass prophylaxis sites - throughout County. Sites would be
    large facilities such as school gymnasiums or warehouses that can accommodate
    large groups of people.

•   Sites would require large number of health care providers to administer medications.
    Since county does not employ enough practitioners to staff sites, they will look to
    private sector, including clinics, to adequately staff mass prophylaxis sites.



                                    The Wilson Group 6-04                              149
                       EOP TEMPLATE: RESPONSE
    ______________________________________


2.5.2
LOCAL ALERT SYSTEMS (E.G., HEALTH ALERT SYSTEM EMERGENCY
NETWORK (HASTEN)).

•   Medical Director & Nursing Director will be registered with local alert
    system & will remain current on infectious disease outbreaks & other
    emergencies countywide. Other physicians will also be encouraged to
    register, as well.




                              The Wilson Group 6-04                     150
                     4. RECOVERY



4.1   INTRODUCTION
4.2   DOCUMENTATION
4.3   INVENTORY DAMAGE AND/OR LOSS
4.4   LOST REVENUE THROUGH DISRUPTION OF SERVICES
4.5   COST / LOSS RECOVERY SOURCES
4.6   PSYCHOLOGICAL NEEDS OF STAFF & PATIENTS
4.7   RESTORATION OF SERVICES
4.8   AFTER-ACTION REPORT
4.9   STAFF SUPPORT




                      The Wilson Group 6-04         151
                         EOP TEMPLATE: RECOVERY

   4.8 Refers APPENDIX P.9: AFTER ACTION REPORT QUESTIONNAIRE

                                      QUESTION

1. Were procedures established & in place for response to disaster?
2. Were procedures used to organize initial & ongoing resources?
3. Was ICS used to manage field response?
4. Were all ICS Sections used?
6. Was EOC activated?
7. Was EOC organized according to ICS?
8. Were sub-functions in EOC assigned around five ICS functions?
9. Were response personnel in EOC trained?
10. Were action plans used in EOC?
11. Was coordination performed with volunteer agencies (e.g., Red Cross)?
12. Was Operational County EOC activated?
13. Was assistance requested & received?

                                 The Wilson Group 6-04                      152
      IV.  SPECIAL ISSUES AT THE FOREFRONT:
        IMPLEMENTATION OF TEMPLATE ON SELECT
                        TOPICS
_______________________________________________


  •         HAZARD VULNERABILITY

  •         MENTAL HEALTH

  •         WEAPONS OF MASS DESTRUCTION (WMD): BIO-TERRORISM

  •         CRISIS COMMUNICATIONS

  •         SPECIAL POPULATIONS

  •         CONTINUITY OF OPERATIONS

  •         INFECTION CONTROL


                            The Wilson Group 6-04              153
V. COLLABORATION, PARTNERSHIP BUILDING, & RESOURCES
      ____________________________________

 Emergency Management Program Implementation Resources & References,

 Supporting Organizations,

 Potential Partners,

 Future Training Opportunities

 Potential Challenges to Preparedness

 Funding Opportunities & Strategies

 Sharing Best practices with other Clinics

                              The Wilson Group 6-04                154
    Clinic Emergency
Preparedness Training and
  Funding Opportunities




         The Wilson Group 6-04   155
     FY2002 HRSA Grant Overview

• California and the County of Los Angeles were
  allocated HRSA funding for hospital and health
  system preparedness planning.
• CA received a $9.9 million grant and Los
  Angeles County received $3.6 million.
  – Clinic Emergency Preparedness Project was funded
    through the State and Los Angeles County HRSA
    grants.




                     The Wilson Group 6-04             156
      FY2003 HRSA Grant Overview
State HRSA FY03 Allocation- $38.8 million
• HRSA Guidance is now an “all hazards” approach to
   emergency planning
• Clinics secured approximately $2 million in funding and
   equipment:
   – Emergency Preparedness Coordination consortia/clinic
     staff
   – Medical Supplies
   – Personal Protection Equipment (PPE)
   – Radio communications
   – High-speed internet access with hardware and software
   – Facility generators



                        The Wilson Group 6-04                157
     FY2004 HRSA Grant Overview

• Funding levels remain the same for State and
  Los Angeles County
• State will allocate the majority of the funding via
  local/regional planning groups.
• Los Angeles County will fund clinics through the
  grant application process.




                     The Wilson Group 6-04         158
                             Cal•PEN


California Preparedness Education Network
• Mission:
   – Prepare California health professionals caring for the state’s
     multicultural underserved to rapidly and effectively respond to
     terrorism and other public health emergencies
• Federally funded through HRSA
• Focus on medically underserved communities




                           The Wilson Group 6-04                 159
               Cal•PEN Training - 5 goals



1. Recognize the risk of a natural disaster, local terrorist
   event or public health emergency
2. Recognize the indications of a natural disaster, terrorist
   event or other public health emergency
3. Meet immediate care needs of patients
4. Alert appropriate authorities
5. Participate in response




                          The Wilson Group 6-04                 160
            Cal•PEN Training - Modules

•   Disaster Preparedness
•   Bioterrorism Preparedness
•   Chemical and Radiological Events
•   Emerging Infections




                     The Wilson Group 6-04   161
         Cal•PEN Contact Information

• Scheduling and Further Information
  – Northern California
      Beth Greenwood          bgreenwood@shastahealth.org
  – San Jose and Vicinity
      Marianne Levin          calpen@chpscc.org
  – Central Coast
      Steve Lustgarden        steve@hpcn.org
  – Los Angeles
      Franco Reyna            mahec@msn.com
  – San Diego
      Hilda Araiza            araiza.hilda@scrippshealth.org


                         The Wilson Group 6-04                 162
      EMSA’s CBRNE Training CD

• Four-level training for medical care providers
  and responders on disaster planning and
  response to:
   – Chemical agents
   – Biological agents
   – Radiological agents
   – Nuclear
   – Explosives



                    The Wilson Group 6-04          163
             Clinic Template Builds Network:
   Essential Action: Interface with Local Partners
__________________________________

BRAINSTORM: Identify agencies in your area with
responsibility for emergency mitigation, preparedness, response,
& recovery



           COLLABORATION




                        The Wilson Group 6-04                 164
       EMERGENCY SIMULATIONS:
             Practice Using EOP -


Multi-Hazard Scenarios:

      Questions

          Actions – Interactive Response

                  Discussion


                  The Wilson Group 6-04    165
  CLINIC NEXT STEPS: Utilize EOP Guidance
           Test Plans to ensure “A Living Document”

________________________________________________


 ON-GOING CLINIC MANAGEMENT & STAFF VISION:

          PRIORITY FOR EFFECTIVE RESPONSE

              PROACTIVE COMMITMENT

                         ACCOUNTABILITY



                          The Wilson Group 6-04       166

				
DOCUMENT INFO
Description: Nurse Manager Resume Template document sample