Hazard Planning for Hospitals Large and Small Darrell Ruby, CEM Region 9 Coordinator

Today’s Discussion Emergency Planning. Hazard Vulnerability Analysis (HVA). What is it, who does it, why? Why plan? Planning references. – Federal, State, Local Getting started. HVA Tool.

Emergency Planning for Hospitals 5 W’s plus…. – Who should be involved? – What are the requirements? – When should you do it? – Where do you begin? – Why and How often? – What resources do you use?

Whole Community – Unity of Effort Preparedness is a shared responsibility. Everyone plays a role:  Individuals and families, including those with disabilities or others with access and functional needs  Businesses and nonprofits  Faith-based and community organizations  Schools and academia  Media outlets  All levels of government

Risk-Driven, Capabilities-Based Natural hazards Pandemic influenza Technological and accidental hazards Terrorist attacks Cyber attacks

Hazard Vulnerability Analysis (HVA) Hospitals are required to conduct and annually review their Hazard Vulnerability Analysis (HVA). The HVA provides a systematic approach to recognizing hazards that may affect demand for the hospitals services or its ability to provide those services. The risks associated with each hazard are analyzed to prioritize planning, mitigation, response and recovery activities. The HVA serves as a needs assessment for the Emergency Management program. This process should involve community partners and be communicated to community emergency response agencies. It is important to note that cities and counties are also required to prepare HVAs; the hospital HVA should consider hazards identified in the community plans that may impact the hospital. In some communities the hospital and community HVAs are developed together. Also referred to as Hazard Identification and Vulnerability Analysis (HIVA) or Threat and Hazard Identification and Risk Analysis (THIRA) ~ New

PPD - 8 Presidential Policy Directive (PPD) 8: National Preparedness was released in March 2011 with the goal of strengthening the security and resilience of the United States through systematic preparation for the threats that pose the greatest risk to the security of the Nation. PPD-8 defines five mission areas—Prevention, Protection, Mitigation, Response, and Recovery—and mandates the development of a series of policy and planning documents to explain and guide the Nation’s approach to ensuring and enhancing national preparedness.

National Planning Frameworks ords/11954

National Preparedness Goal Prevention. Prevent, avoid or stop an imminent, threatened or actual act of terrorism. Protection. Protect our citizens, residents, visitors, and assets against the greatest threats and hazards in a manner that allows our interests, aspirations, and way of life to thrive. Mitigation. Reduce the loss of life and property by lessening the impact of future disasters. Response. Respond quickly to save lives, protect property and the environment, and meet basic human needs in the aftermath of a catastrophic incident. Recovery. Recover through a focus on the timely restoration, strengthening and revitalization of infrastructure, housing and a sustainable economy, as well as the health, social, cultural, historic and environmental fabric of communities affected by a catastrophic incident.

Mitigation Core Capabilities Mitigation ~ Sustained actions taken to reduce or eliminate long-term risk to life and property from hazards.* 44 CFR §201.2 Mitigation Planning - Definitions The National Preparedness Goal identified 31 core capabilities - these are the distinct critical elements needed to achieve the goal.

CPG – 101: Developing and Maintaining Emergency Operations Plans (EOP’s) This Guide provides information and instruction on the fundamentals of planning and their application CPG – Comprehensive Preparedness Guide

CPG – 201: Developing and Maintaining Emergency Operations Plans (EOP’s) Threat and Hazard Identification and Risk Assessment (THIRA) guide provides a comprehensive approach for identifying and assessing risks and associated impacts. It expands on existing local, tribal, territorial, and state Hazard Identification and Risk Assessments (HIRAs) and other risk methodologies by broadening the factors considered in the process, incorporating the whole community throughout the entire process, and by accounting for important community-specific factors CPG – Comprehensive Preparedness Guide

CPG – 201: Threat and Hazard Identification and Risk Assessment (THIRA) Five Step Process 1.Identify the threats and hazards of concern - What could happen in my community? 2.Give the threats and hazards context - Describe how a threat or hazard could happen in my community, and when and where it could happen. 3.Examine the core capabilities using the threats and hazards - How would each threat or hazard affect the core capabilities identified in the National Preparedness Goal? 4.Set capability targets - Using the information above, set the level of capability a community needs to prevent, protect against, mitigate, respond to, and recover from its risks. 5.Apply the results - Use the capability targets to decide how to use resources from the Whole Community. CPG – Comprehensive Preparedness Guide

Local Mitigation Planning Handbook Handbook highlights case studies and tools for community officials providing practical guidance on how to incorporate risk reduction strategies into existing local plans, policies, codes, and programs that guide community development or redevelopment patterns. Task 5 – Conduct a Risk Assessment

Defining Risk Assessment Illustrates the concept of risk as the relationship, or overlap, between hazards and community assets. The smaller the overlap, the lower the risk.

Risk Assessment Terminology Natural hazard – source of harm or difficulty created by a meteorological, environmental, or geological event. Community assets – the people, structures, facilities, and systems that have value to the community. Vulnerability – characteristics of community assets that make them susceptible to damage from a given hazard. Impact – the consequences or effects of a hazard on the community and its assets

Risk Assessment Terminology (Continued) Risk – the potential for damage, loss, or other impacts created by the interaction of natural hazards with community assets. Risk assessment – product or process that collects information and assigns values to risks for the purpose of informing priorities, developing or comparing courses of action, and informing decision making. Threat or human-caused incident – intentional actions of an adversary, such as a threatened or actual chemical or biological attack or cyber event.

References/Statutes ** Revised Code of Washington, Chapters 38.10, 38.52, 43.21, Public Health Service Act Public Law , as amended, "The Robert T. Stafford Disaster Relief and Emergency Assistance Act" National Response Framework (NRF) Public Law , Public Health Security Bioterrorism Preparedness and Response Act 2002 Public Law , Homeland Security Act 2002 Federal Food, Drug and Cosmetic Act ** As identifed in the WA State CEMP, ESF 8 – Public Health and Medical Services

Joint Commission (aka JCAHCO) Mission: To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.

So now that we are all on the same page…… Let’s look at a specific tool created for hospitals.

Where do you start? Issues to consider for probability include, but are not limited to: 1Known risk 2Historical data 3Manufacturer/vendor statistics Issues to consider for response include, but are not limited to: 1Time to marshal an on-scene response 2Scope of response capability 3Historical evaluation of response success Issues to consider for human impact include, but are not limited to: 1Potential for staff death or injury 2Potential for patient death or injury Issues to consider for property impact include, but are not limited to: 1Cost to replace 2Cost to set up temporary replacement 3Cost to repair Issues to consider for business impact include, but are not limited to: 1Business interruption 2Employees unable to report to work 3Customers unable to reach facility 4Company in violation of contractual agreements 5Imposition of fines and penalties or legal costs 6Interruption of critical supplies 7Interruption of product distribution Issues to consider for preparedness include, but are not limited to: 1Status of current plans 2Training status 3Insurance 4Availability of back-up systems 5Community resources Issues to consider for internal resources include, but are not limited to: 1Types of supplies on hand 2Volume of supplies on hand 3Staff availability 4Coordination with MOB's Issues to consider for external resources include, but are not limited to: 1Types of agreements with community agencies 2Coordination with local and state agencies 3Coordination with proximal health care facilities 4Coordination with treatment specific facilities

Threats/Hazards by Category

Natural Hazards

Technology Hazards

Human Hazards

Hazardous Materials

Summary of Hazards

Open Discussion How do you plan? Who do you plan with? Best practices Lesson’s Learned Who should be involved? When do you do it? Where do you begin? What resources do you use? Just your hospital? How do you involve the community?

Links and Articles California Hospital Association Website vulnerability-analysis Planning Resources for Hospitals - CDC Strengthening HVA: Results of Research in Maine Cyber hazards and health care organizations,

Thanks, for your time and participation. Contact info: Darrell Ruby

Back-ups

Natural Hazards

Technology Hazards

Human Hazards

Hazardous Materials

Summary of Hazards