North Central Wisconsin Healthcare Emergency Readiness Coalition NCW HERC http://www.ncw-herc.org/ NCW HERC Workshop: Emergency Operations Plan (EOP) Review and Development Presented October 10, 2018

Division of Quality Assurance (DQA) serves as the state survey agency that oversees Wisconsin’s certification process on behalf of CMS. DQA has provided information and background on the CMS rule, and the provider specific tools were produced independently and are intended for advisory purposes only.   None of the tools or assistance provided by NCW HERC guarantees any outcome during survey visits. Facilities are solely responsible for meeting CMS requirements. Disclaimer

Objectives Identify methods, resources and assets to strengthen your EOP  1 Conduct an annual review of your EOP 2 Collaborate with peers to identify best practice 3 Leave with heading for improvements and WORK TO DO. 4

Logistics/Crowd Participation Brief review and break out Reference your EOP Share the good stuff! Share your struggles Ask questions and get something out of this!

Who's in Attendance? Hospitals Fed Qualified Health Centers Ambulatory Surgical Centers Community Mental Health Center Comp. Outpatient Rehab Facilities End Stage Renal Disease Facilities Hospice Intermediate Care Facility Organ Procurement Organization Physical/Speech Therapy Outpatient Rural Health Clinics Home Health Agencies Long Term Care & Skilled Nursing Home Facilities Who's in Attendance?

Disaster Statistics In preparation of Hurricane Florence at least 40 hospitals and at least 10 skilled nursing facilities were evacuated ahead of the storm. At least 135 residents of nursing homes within the Houston area perished during Hurricane Harvey.  Beaver Dam bomb maker. Over 1,850 nursing homes have failed to have emergency evacuation plans in place between 2011 and the present time.  CMS reports that there were 3,770 violations of weekly and monthly power generator inspections in nursing home facilities. The Gerontological Society of America cited in a 3-year study that there was a 218% increase in mortality of residents with severe dementia within 30 days and a 158% increase in mortality within 90 days of an evacuation from gulf coast.

Why? Legal and Moral Responsibility Save lives and property Insurance reductions Effective Response Why?

Who? Emergency Planner/ Coordinator/ Manager Local Emergency Planning Committee

CO-S-TR CO Command Control Communication Coordination S Staff Space Special TR Tracking Triage Treatment Transportation

Essential Functions of an EOP Communication Resources and Assets Safety and Security Staff Responsibilities Utilities Management Patient and Clinical Support Activities Regular Testing and Evaluation

Resources CMS EP Checklist: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Downloads/SandC_EPChecklist_SA.pdf CMS Rule Core Elements: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Core-EP-Rule-Elements.html ASPR TRACIE EOP Management Tools: https://asprtracie.hhs.gov/technical-resources/84/emncy-operations-plans-emncy-management-program/1 FEMA EOP Guide for EOPs https://www.fema.gov/media-library-data/20130726-1828-25045-0014/cpg_101_comprehensive_preparedness_guide_developing_and_maintaining_emergency_operations_plans_2010.pdf DHS CMS Preparedness Toolkits https://www.dhs.wisconsin.gov/preparedness/toolkits.htm

Risk Assessment/ Planning Hazard Vulnerability Assessment (HVA) NCW HERC Regional Review Triggers for Activation Continuity of Operations Feb 2019

Breakout Discussion #1 (15 min) What are my top 10 threats? What are my triggers to activate the EOP? Who activates the EOP? What are my essential services to continue?

Communication Internal and External Partners Communication Plan (Risk Communication) Redundancy Expanding an incident NCW HERC's role in the tiered response EMResource Virtual Operations Support Team

Breakout Discussion #2 (15 min) How do I communicate internal activation? How do I notify external partners of activation? What are my primary and redundant means of communication? Are external partners aware of role in response in my EOP? How do I communicate to the public? Public Information Officer? How do I communicate resource needs? Do I formally engage the HERC?

Resources/Assets & Utility Management Subsistence Needs Food & Water Medical & Pharmaceuticals Linens Alternate Sources of energy Waste management!!!! Contracts, Vendors and MOUs Conservation of Resources Shelter in Place Evacuate Large Patient Influx

Breakout Discussion #3 (15 min) What contracts do I have established with vendors? What is my plan if the vendors are unable to provide? What MOUs do I have established with partners I may need stuff from? Do you have generators? What are they capable of running? How long and they run? What agreements do I have with partners I may need to collaborate with in evacuation? What conservation strategies have been identified?

Patient & Clinical Support Incident Command Structure(ICS) Staff Tracking Surge staff Patient Tracking Volunteers Records/ Documentation Security

Breakout Discussion #4 (15 min) What staff are responders? What staff are command? How will staff be assigned in ICS? How does your facility account for patients? How does your tracking change in an emergency? How is information protected or preserved? How can it be accessed to be shared? What measure are taken to protect patients and staff?

Testing, Review & Evaluation Training Incident command Onboarding Testing Exercising Exercise Evaluation Guides (EEGs) After Action Reports (AARs)

Breakout Discussion #5 What is your process for training staff needed to respond? Managers and key decision makers? How often are refreshers? What does your outlined incident command depth chart look like? How do you prioritize exercising? What are your highest priority drills and exercised need related to your HVA?

Closing Comments and Discussion

Thank you! For questions related to this workshop, please contact robert.deede@wi.gov or via phone at 715-360-6822