Mark Stanovich Director of Preparedness, VAHHS

Transcription

1 Disaster Logistics Planning for The Worst Mark Stanovich Director of Preparedness, VAHHS

2 Luck is the residue of design. For want of a nail Failing to plan is planning to fail. Amateurs talk tactics. Professionals talk logistics.

3 Definition of Terms: Emergencies and Disasters

4 What is an emergency? A disaster? Many definitions and descriptions of each Stafford Act *- delineates a disaster as being more serious than an emergency Both disasters and emergencies are usually unexpected events, occur without lead-time for mitigation of risk/dangers *Robert T Stafford Disaster and Emergency Assistance Act

5 For our purposes today: Emergency: an event that stresses system capability and capacity in performing critical functions Disaster: an event that stresses system capability and capacity, while capacity for operation has been reduced due to damage or outage

6 The occurrence of a disaster or emergency causes many supplies and capabilities to immediately be in critically short supply

7 Emergency: Mass casualty incident, food-borne illness outbreak, building fire, chemical spill. Disaster: Earthquake or flood that damages hospital facility, contagion outbreak that affects staff, severe weather that causes outages of critical services.

8 Identifying Characteristics of Similar Events

9 General Characteristics Severe weather or natural disasters usually include: Widespread structural damage Loss of essential services Life threatening conditions Trauma injuries Staff shortage Days to weeks in duration Expenditure of resources high Backup systems must be functional

10 General Characteristics Mass Casualty Incident: Patient surge Life threatening trauma injuries Trauma injuries Staff shortage Transportation requirements Hours to days in duration Expenditure of resources high Surge in staff necessary

11 General Characteristics Contagion outbreak (influenza or other disease) Potential for rapid increase of patient population Requirement for isolation of contagious patients Public information campaign/public anxiety Life support equipment in high demand Staff shortage Weeks to months in duration High demand for PPE Restrictions of transfer to unaffected areas

12 Knowing What You Have: Pre-event Inventory

13 Pre-event inventory of essential supplies and status of critical equipment Understanding characteristics of the likely hazards your hospital faces is the key to preparing for those hazards. Hospitals are required to conduct an annual review of their respective facilities Hazard Vulnerability Analysis as a means to focusing preparedness and mitigation efforts

14 Pre-event inventory of essential supplies and status of critical equipment Pre-event inventory of supplies and assets is CRITICAL to a rapid and effective response to an emergency or a disaster. The Hospital Incident Commander MUST know what resources and capabilities are available to respond and does not have the luxury of time for compiling that information.

15 Pre-event inventory of supplies and assets is a Joint Commission requirement: 2009 Emergency Management Standards EM EP:8 The hospital keeps a documented inventory of the resources and assets it has on site that may be needed during an emergency, including, but not limited to, personal protective equipment, water, fuel, medical, surgical, and medication related resources and assets.

16 Vermont Hospitals Emergency Operation Plan (EOP) templates include pre-event inventory and reporting of: Power Water Generator status/fuel Pharm inventory (antibiotics, anti-virals, narcotics) HVAC (it gets COLD in VT) Medical Gases PPE Ventilators/Negative Pressure

17 Emergency Operations Plan should specify whom is responsible for maintaining status and inventories, whom they are reported to, and at what frequency/situations. Use common sense Briefing by exception If issue or problem with item, make sure updates are reported

18 NIMS/ICS and HICS: A Common Command Structure

19 Adoption of the National Incident Management System (NIMS) in accordance with HSPD-5 in March of 2004 Common Command Structure for Managing Emergencies and Disasters Ensures all critical staff functions are assigned Hospital Incident Command System IV (HICS IV) is a direct descendent of the Incident Command System

20 Hospital Incident Command System Compatible with NIMS/ICS and National Response Framework Similar staff structure Common delineation of duties Recognizable to outside entities Hospital friendly version

21 Logistics Section of Hospital Incident Command Safety Liaison Incident Command PIO Medical/technical Specialists Operations Section Planning Section Logistics Section Admin/Finance Section Branch Branch Branch Branch Unit Unit Unit Unit

22 Logistics Section Support requirements will be coordinated by the Logistics Section. These responsibilities include: Acquiring resources from internal and external sources Using standard and emergency acquisition procedures and requests to the local (EOC) or the RHCC. Each resource request from an area in the hospital should be reported to the Logistics Section using pre identified ordering procedures outlined in the EOP. When requesting resources from outside sources it will be important that the hospital specify exactly what their need is and not try to identify how that need can be met.

23 Logistics Section Depending on the size and complexity of the incident, the Logistics Section can be divided into two branches. The Service Branch will often include Communications Unit (including IT resources and services), and sometimes Food Service Unit, which provides food and water to staff. The Support Branch usually includes Facilities and Transportation Units, and will have a Labor and Credentialing Unit, to coordinate the arrival and credentialing of additional personnel. Other subdivisions may be required depending on the scope of the response required.

24 Logistics Section Communications Requirements

25 Logistics Section Communications Own hospital departments and clinics Operations, Planning, and Finance/Admin Sections Other hospitals Vendors/Businesses Local Emergency Operations Centers Area Commands State Emergency Operation Center Joint Field Office (If Federal response is on scene) Imperative to maintain up to date communications information and phone lists for each of these entities.

26 Logistics Section Communications Proactive in maintaining situational awareness of supply levels, anticipate requirements. Must compute expenditure rates, perform predictive analysis, in order to know what items or capabilities will become critical first.

27 Operations Section Identifies the need/requirement and requests Planning Section Documents the request in IC and passes to Log Acquisition of Supplies and Materials under HICS Logistics Section Sources (acquires) Item/Requirement Finance - Admin Section Pays Invoice or initiates Contract

28 Critical Situational Information The Logistics Section of Hospital Incident Command should evaluate which items of information regarding supply levels and equipment status are critical to management of an incident. The information items that require closest monitoring should be considered for display in the Hospital Command Center. Coordination with the Situation Unit of the Planning Section will be required to do this.

29 State and Federal Roles: Assistance in Declared Disasters and Emergencies

30 State Emergency Operations Center (SEOC) Established by Vermont Emergency Management in Waterbury Fifteen State Support Functions (SSFs) SSF-8 is Health and Medical Services State EOC provides guidance and information regarding policies and measures enacted in response to conditions caused by an incident Logistical support and sourcing of supplies/capability

31 VDH Health Operations Center (HOC) Incident command node for VDH located at Cherry St, in Burlington, manages the requirements of the health care network and SSF-8 Supplies state-wide coordination of healthcare issues in an emergency or disaster Conduit of official information for hospitals and health care facilities from CDC, VDH, and other public health entities Operates Patient Coordination Unit, which manages patient load across the Vermont hospitals in order to spread-load local surges

32 National Emergencies Act of 1976 Premise for recent Presidential Declaration of Emergency Temporarily opens Federal regulation to waiver or suspension (which regulation depends on the scope and nature of the incident) Current declaration is for Public Health Emergency (waiver of parts of Section 1135 of SSA, the so-called 1135 waiver ) Must be declared at the Federal level, limits on duration of emergency provisions (forces legislation change or cancellation) Little Federal reimbursement other than some limited items of direct cost (implemented to comply with Federal guidance)

33 Stafford Act Declaration Robert T. Stafford Disaster Relief and Emergency Assistance Act Can be declared by a State Governor or by the President (State governor has to request a Federal Declaration) May cover the following geographic entities: Tribal Area or Municipality County Sub-state region State All of US Cost-sharing provision of 75% Federal reimbursement

34 Stafford Act Declaration Governor has powers in VT under Title 20 (Internal Security and Public Safety) upon declaration of an emergency or disaster under Stafford In order for the Governor to request a Federal Declaration: Scope of effort exceeds state and local resources Implementation of State Emergency Plan and meets all state legal obligations for emergency response Preliminary Damage Assessment (PDA) either unilaterally or jointly with FEMA Regional Director.

35 Federal Assistance Available under Stafford Act Declaration Financial assistance (grants and loans) Equipment, supplies, facilities for temporary use Medical supplies Food and water, consumables Work services that include: Search and Rescue Debris removal Road repair and bridge construction (required for emergency services) Temporary school facilities Structure demolition Technical advice and assistance

36 Review: Definitions of emergencies and disasters Identifying common characteristics of events Pre-event inventory Common command structure with NIMS/ICS and HICS Communications requirements Role of State and Federal entities to provide assistance

37 Questions? Mark Stanovich Director of Preparedness Vermont Assn of Hospitals and Health Systems