Mexico 2017

Santa Barbara County Disaster Healthcare Partners Coalition Presents Disaster Exercises How to conduct a disaster exercise that prepares your staff & meets CMS disaster rule requirements

Welcome EARTHQUAKE Scenario: Post on the board! Write down: 2 things you think your facility or agency should practice for an earthquake event Post on the board!

Santa Barbara County Public Health Emergency Medical Services Agency and Emergency Medical Services Agency Jan Koegler, MPH Program Manager Stacey Rosenberger, MPH Emergency Planner

Mexico 2017

Agenda: Disaster Exercises Benefits and requirements for disaster exercises How to conduct a “tabletop” exercise Required forms: Exercise plans and after action reports How to conduct a full scale exercise Practice: Let’s conduct a full scale exercise

Benefits and Requirements of Disaster Exercises Prepares and protects your clients, facility, or agency Educates your staff re: procedures Team building Meets accreditation or licensing requirements Meets Centers for Medicare- Medicaid disaster rule requirements

Four core elements of CMS rule Emergency Plan Based on a risk assessment Use an all- hazards approach to risk assessment Update plan annually Policies & Procedures Develop based on risk assessment and emergency plan Must address: subsistence of staff and patients, evacuation, sheltering in place, tracking patients and staff Review/Update annually Communications Plan Complies with Federal and State laws Coordinate patient care within facility, across providers, and with state and local public health and emergency management Annual update Training & Exercise Program Develop training program Initial and annual training on policies & procedures Conduct drills and exercises Tabletop annually Full-Scale community based exercise annually

Annual Exercise requirements Conduct one FULL SCALE EXERCISE annually Must participate in a community based exercise if offered The PHD annual medical and health exercise in November is a community based exercise SNF/ICF’s have option to do PHD/ EMS Agency annual evacuation exercise as full scale Conduct one additional exercise Can be a tabletop exercise

Types of Disaster Exercises TABLETOP FUNCTIONAL FULL-SCALE “Talk –Thru” Demonstrates: Knowledge of policy/ procedures Facilitator presents a scenario and ask key staff questions. Staff should answer according to existing policies and procedures Determine additional policy and procedures needed “Hands On” Facility ability to locate and activate plans, assign roles. Activate Command Center. Communication with partners Staff knowledge of forms and procedures Activate staff call back and alerts. “Walk-Thru” Ability to activate command center according to policy, communicate, assign roles, use checklists and policies AND Moves patients, supplies, equipment, staff Triage for patients Set up of surge areas Use of generator to test essential services Use of paper forms.

Disaster Exercise Process Read/Train Procedure Discuss Procedure “talk thru” Do Procedure “walk thru”

Tabletop “Talk-thru” Large OR Small

Step 1: Assemble planning group Who to Invite to a planning meeting: Who is responsible for emergency operations during a real event? Administrator, managers, supervisors Who is responsible for writing emergency plans and procedures? Safety officer, environmental services, other Who is responsible for safety and facilities day to day? Facilities personnel, office administrators

Step 2: Meet with Planning group Present the hazard “Earthquake that disrupts utilities and damages facilities” Determine policies and procedures to test Earthquake procedures Utility outage procedures Request a facilitator for the tabletop Staff who is used to facilitating meetings Hired or volunteer facilitator Determine who to invite and date/time of exercise

Who will Facilitate?

Step 3: Determine Objective (s) to “Test” You can’t test everything in your policy/procedure Prioritize and pick 1-3 objectives: “Exercise our SNF facility plan to provide care with a loss of utilities for 36 hours after an earthquake” Write a scenario that sets the scene Develop questions to “test” your policies and procedures Assign a Scribe: to capture answers/suggested improvements for your after action report

Tabletop Template

Tabletop Exercise Plan Template

Tabletop Exercise Plan Template Do you want to provide these plans, policies, or procedures in advance?

Sample Tabletop Questions In the “Situation Manual Tabletop Template”

Tabletop in Action : Let’s Practice Staff and Supplies: Facilitator Scribe(s) Whiteboard or Large Sticky Paper/Pens so that comments are seen by all Evaluation Forms

Tabletop in Action: Let’s Practice Scenario: Today at 5:00 pm a 7.4 earthquake occurs. Power is out and cell communication is sporadic. Power is not expected for 72 hours. It is 90 degrees. Our facility appears to have suffered at least some damage and at least 5 injuries of staff and patients are reported. Objectives for the Tabletop Exercise facility ability to provide essential care after an earthquake with a 72 hour power outage Exercise facility ability to communicate with staff during a disaster with limited cell service. Other: What do you want to practice?

Tabletop in Action: Questions to “test” your policies and procedures Objective: Exercise facility ability to provide essential care after an earthquake with a 72 hour power outage What actions are our staff supposed to take during an earthquake? Is this stated in a policy or safety plan? Where is the procedure located? Does our facility have a plan to assess and treat staff and patients/clients injured during an earthquake? If yes, where is it? When were staff trained on this plan? Have we tested this procedure?

Tabletop in Action: Questions to “test” your policies and procedures Objective: Exercise facility ability to provide essential care after an earthquake with a 72 hour power outage “What type of heating and cooling can we provide during the impact of the power outage?” “Who is responsible for the HVAC? Where do they live? Who is the back up?” “According to our procedure, how will you communicate with the next shift of staff?”

Tabletop in Action: Questions to “test” your policies and procedures “Power is out and cell communication is sporadic.” Objective: Exercise facility ability to communicate with staff during a disaster with limited cell service. “Do we have an emergency communication plan” “According to our procedure, how will you communicate with the next shift of staff?” “What is our facility’s plan to communicate with staff on shift? And off shift?” “Do we need to write a communication plan or procedure for disasters/outages?”

Tabletop Debrief “Hot Wash” For each question wrap up with a review and ask participants (noting responses): What did you learn during the tabletop? What went well? What critical issues for improvement were noted? What additional critical issues did you identify? What do we need to do now? Get participants’ commitment to next steps: Add a back up generator maintenance role Provide staff with generator training Update procedure

Participants Evaluate Tabletop

After Action Report

What is a Full Scale Exercise? Staff demonstrate knowledge of emergency plans Moving people & equipment Activating Plans We will help you understand how to do a full-scale exercise!

Disaster Exercise Process Read/Train Procedure Discuss Procedure “talk thru” Do Procedure “walk thru”

Training on Procedures

Tabletop “Talk-thru” Discussion Large OR Small

Full Scale Exercise – Do Procedure Forms you will need: Full scale exercise plan Schedule of exercise events and evaluation guide Participant evaluation form After action report

Full Scale Exercise Plan: Template

Template: Full Scale Exercise Plan

Template: Full Scale Exercise Plan

Template: Full Scale Exercise Plan- Safety

Template: Full Scale Exercise Plan- Schedule of Events AND Evaluation

Template: Full Scale Exercise Participant Feedback Form

Template: Full Scale Exercise After Action Report

Full Scale Exercise - Activities Earthquake/Evacuation of facility: Accounting for patients/clients/public Activating your response plan Activating “Who is in charge” command structure Triage and treatment of injured Accessing and using your emergency supplies Tracking patients/clients who are moved Practicing Communication Plan Assessing and reporting your status to PHD Making a resource request Conducting a building assessment

Evacuation-How will you exercise? Move from one side of building to another Move mock patients or real patients out of building Collect personal belongings, medical records, medication etc. Time test how long it will take Make sure staff account for clients and follow all procedures for residential clients Reminder: Review your CMS and accreditation requirements-differs by facility type

Full Scale Evacuation of ICF

Full Scale: Accepting Evacuees

Full Scale: Mock Evacuees/Patients

Full Scale: Power Outage Activities Demonstrate and evaluate how your agency/facility would do in a power outage: Staff access disaster plan, patient forms, and conduct a staff call back without power or only generator power Turn off power and go to generator only. Have staff care for patients on generator only (or no power). Staff demonstrate actions required in plan related to keeping patients safe if no HVAC Administrator decides at what point evacuation from facility or home (home health) is necessary Have staff demonstrate ability to access all lanterns, lights, fans, etc. and assess their functionality/capacity.

Full Scale: Sewage Outage Staff demonstrate what agency/facility would do in a sewage outage: Set up emergency toilet supplies and determine how long they would last Set up emergency handwashing supplies and determine how long they would last Staff use plan/procedure that states what you will do if no sewage Make requests for portapotties through vendor, public health, or city EOC.

Full Scale: Food and Water Determine requirements and/or need for food and water supplies in your facility or agency Staff assess food and water status Report how long food and water would last Get out your disaster menu

Full Scale: Medical Surge Set up area for patient care overflow inside building or in parking lot Use tents or pop ups, conference rooms, waiting areas Bring out surge supplies Assign staff to areas and roles Prepare for injured from earthquake or for patients from a damaged facility Example: Isla Vista Clinic patients go to UCSB student health

Full Scale Demonstration Hand colored card admin (leader + 5 +procedure), staff (25-5 injured), clients/patients (20-10 that are injured Play earthquake sound Drop and cover Injured stay where you are Set up command structure Use PHD earthquake checklist or hospital incident command guide, building assessment form, status form, staff accounting form, first aid kit

Getting Ready for Full Scale Exercise Tabletop policies and procedures Make any changes to policies and procedures that were identified during the tabletop Train staff on policy & procedure changes Identify areas you want to test during full scale exercise Develop exercise plan (schedule, who will participate, clients or patients involved, actors, logistics etc.) and provide staff with information about the exercise (possible training on their roles)

Training on Procedures

Basic Areas to Test: Set up Command Structure Set up your ICS structure and assign staff to roles Triage and Treat Identify staff and patients that have been injured during the event- triage & treat Assess Your Facility Assess your facility: structure, power, water etc. Communicate your status Communicate the status of your facility to the PHD and licensing

Let’s Practice Full Scale

Your Role X= injured and unable to move L = Incident Commander Purple = Command Staff Yellow = Staff Blue = Patients/Clients/Re sidents Evaluator=2 X= injured and unable to move L = Incident Commander

Command staff- following the earthquake come to the front of the room to get your assignments Staff- check on your patients and conduct any tasks command staff assigns you; if injured stay where you are Patients- ask staff what is going on, if injured stay where you are

Debrief “Hotwash” What went well? What could be improved? What supply or equipment issues did you notice? What improvements are needed in our procedures? What kind of training is needed?

Evaluation Form

After Action

Next Steps Conduct Full Scale Exercise on or before November 16th Attend October 10 or 12 training Plan & conduct Tabletop at facility Plan for Full-Scale Exercise Conduct Full Scale Exercise on or before November 16th

Resources http://cosb.countyofsb.org/phd/epp/

Thank You! Please remember to complete & turn in your evaluation