Chapter 1 PLANNING INFRASTRUCTURE [ENTER FACILITATOR’S NAME AND CONTACT INFORMATION] Developed by Troutman Sanders LLP Developed for the Virginia Department of Health Funded by Centers for Disease Control and Prevention

2Planning Infrastructure

3 Toolkit Presentations Instructions for Use  Toolkit Presentations are intended to be a companion to the Hospital Implementation Guide and should not be used in isolation.  The Presentations are intended to serve as a starting point for the facilitator. The facilitator should thoroughly review the Presentation prior to use in Implementation Team, CRAG or Subcommittee meetings and customize the Presentation to meet the unique needs of the meeting participants.  Pay particular to attention to the information provided in brackets ([ ]), which must be completed by the facilitator prior to use.  Included in the “Notes” section of each slide are the following types of information: Slide Type, which indicates whether the slide is for information or discussion, serves as a placeholder, or is some combination thereof Planning Guide Section(s), which will direct the facilitator to the corresponding sections of the Planning Guide and Hospital Implementation Guide for further information Special Instructions, which provides directions for the facilitator to customize the slide for the intended audience Speaker’s Notes, which provides more detailed information to supplement the material on the slide  Refer to the Hospital Implementation Guide for further guidance and helpful hints on effectively completing the process described in the Planning Guide.

4Planning Infrastructure Implementation Team  [Enter names and departments of each Implementation Team member]

5Planning Infrastructure Chapter Overview  Identify the “Convener”  Establish an “Implementation Team”  Identify a resource to facilitate the planning activities  Determine the Planning Unit for key activities  Establish CRAGs for each Planning Unit  Set forth clear expectations for planning process

6Planning Infrastructure  Add slides from Altered Standards Overview presentation, as needed, to introduce the Implementation Team to the concept of altered standards and critical resource shortage response planning.

7Planning Infrastructure Introduction to Planning Guide

8Planning Infrastructure Background  Hospitals have done extensive planning for disasters and public health emergencies  Planning for modifying the delivery of care or allocating specific resources and services has lagged behind other planning efforts  A comprehensive framework for dealing with shortages of critical resources was lacking  This is complex and requires a multi-disciplinary approach that combines input from many perspectives -Medical- Operational -Ethics- Public Health -Legal

9Planning Infrastructure Critical Resource Shortages Planning Guide Contributors

10Planning Infrastructure Planning Guide Framework  Develop the critical resource shortage planning infrastructure  Conduct a Critical Resource Vulnerability Analysis  Develop an ethical framework  Develop an operational infrastructure  Identify or develop resource-specific Protocols  Create an ad hoc infrastructure  Engage in collaborative planning with other HMDOs  Determine how the CRSRP will be evaluated and maintained  Obtain approval of the CRSRP and integrate into relevant EOPs  Develop comprehensive communication plans for key audiences

11Planning Infrastructure Terms to Know  Allocation  Critical resource  Critical resource shortage event (CRSE)  Critical Resource Shortage Response Plan (CRSRP)  Disaster or emergency  EMS provider  Goal  Health and Medical Delivery Organization (HMDO)  Modification  Planning Unit  Protocols

12Planning Infrastructure Hospital Implementation Guide  “Teacher’s Edition” of the Planning Guide  Written for the Implementation Coordinator and Team  Chapter Overviews include: Introduction Responsibility Goals for Chapter  Subsections include: Planning Guide text Goal Rationale for inclusion in Planning Guide Real World Examples Action Items for conducting the activity Helpful Hints for implementation Implementation Aids

13Planning Infrastructure Implementation Toolkit  Planning Guide  Hospital Implementation Guide  Project Management Tools and Resources  Meeting Facilitation and Consensus Building Tools and Resources  Other Helpful Resources

14Planning Infrastructure

15Planning Infrastructure Convener Implementation Team Planning Unit CRAG Subcommittee

16Planning Infrastructure Planning Units State Hospital Health System Community Region

17Planning Infrastructure Considerations for Choosing a Planning Unit  Size  Authority  Expertise  Existing relationships  Existing planning efforts

18Planning Infrastructure Considerations for Choosing CRAG Members  Skills and resources needed for assigned key activitiy(ies)  Represent a broad spectrum of disciplines  Strong combination of stakeholders

19Planning Infrastructure Expectations  Roles of CRAG members  CRAG meeting logistics  Budget Cost Contributions from CRAG members Other funding sources  Incentives for CRAG members

20Planning Infrastructure Key Activities

21Planning Infrastructure Strong Foundation Ethical Framework Operational Infrastructure Education & Communication Building the CRSRP Protocol Ad Hoc

22Planning Infrastructure Critical Resource Vulnerability Analysis  Develop a list of critical resources  Prioritize the list of critical resources  Identify mechanisms for mitigating depletion of the resources  Determine which critical resources should be immediately considered for Protocol development  Revisit the CRVA at appropriate intervals

23Planning Infrastructure Which is the appropriate Planning Unit? State Hospital Health System Community Region

24Planning Infrastructure Who should be on the CRAG?

25Planning Infrastructure Expectations  There will be [#] meetings for this CRAG.  The meetings will be held [dates] at [place].  [Name] will facilitate each meeting.  [$] will be budgeted to this group for expenses incurred.  Each member will be compensated [$].

26Planning Infrastructure Ethical Framework  Identify ethical principles  Define the ethical Goal  Determine implementation specifications

27Planning Infrastructure Which is the appropriate Planning Unit? State Hospital Health System Community Region

28Planning Infrastructure Who should be on the CRAG?

29Planning Infrastructure Expectations  There will be [#] meetings for this CRAG.  The meetings will be held [dates] at [place].  [Name] will facilitate each meeting.  [$] will be budgeted to this group for expenses incurred.  Each member will be compensated [$].

30Planning Infrastructure Operational Infrastructure  Determine process for activation and termination of the CRSRP  Determine process for activation and termination of each Protocol  Develop structure for making resource allocation decisions  Develop infrastructure for reviewing and revising CRSRP during a CRSE  Define “essential documentation”

31Planning Infrastructure Operational Infrastructure cont.  Develop process for responding to non- compliance  Identify resources for psychological and emotional support  Develop a communication plan  Develop strategy for providing palliative care during a critical resource shortage event Determine goal Develop standard definition Identify mechanisms for providing palliative care

32Planning Infrastructure Which is the appropriate Planning Unit? State Hospital Health System Community Region

33Planning Infrastructure Who should be on the CRAG?

34Planning Infrastructure Expectations  There will be [#] meetings for this CRAG.  The meetings will be held [dates] at [place].  [Name] will facilitate each meeting.  [$] will be budgeted to this group for expenses incurred.  Each member will be compensated [$].

35Planning Infrastructure Protocol Development  Identify existing surge plan  Identify any relevant Governmental Protocols  Develop Protocol Determine modifications Develop allocation algorithm  Develop an operational plan Identify triage officer(s) and/or triage committee(s) Identify information needed to finalize, revise, modify, or enhance the Protocol during a CRSE Develop a mechanism for revising the Protocol during a CRSE Determine when the Protocol will be activated Determine how and when you will move between tiers of the Protocol Determine when the Protocol will be terminated

36Planning Infrastructure Protocol Development cont.  Identify essential documentation  Coordinate with other Protocols  Memorialize Protocol in writing  Conduct training

37Planning Infrastructure Which is the appropriate Planning Unit? State Hospital Health System Community Region

38Planning Infrastructure Who should be on the CRAG?

39Planning Infrastructure Expectations  There will be [#] meetings for this CRAG.  The meetings will be held [dates] at [place].  [Name] will facilitate each meeting.  [$] will be budgeted to this group for expenses incurred.  Each member will be compensated [$].

40Planning Infrastructure Ad Hoc Protocols  Determine how the Planning Unit will decide when the development of an Ad Hoc Protocol is required  Develop the process by which an Ad Hoc Protocol will be created in the midst of a disaster  Develop a standard mechanism for communicating the creation, implementation, and operationalization of Ad Hoc Protocols

41Planning Infrastructure Which is the appropriate Planning Unit? State Hospital Health System Community Region

42Planning Infrastructure Who should be on the CRAG?

43Planning Infrastructure Expectations  There will be [#] meetings for this CRAG.  The meetings will be held [dates] at [place].  [Name] will facilitate each meeting.  [$] will be budgeted to this group for expenses incurred.  Each member will be compensated [$].

44Planning Infrastructure Coordination with HMDOs  Identify HMDOs for coordination  Create a communication strategy with other HMDOs  Understand how HMDOs’ responses to the CRSE will impact other HMDOs  Engage in discussions regarding changes to scope of services Expansion of scope Reduction of scope  Discuss cooperative initiatives with other HMDOs  Establish parameters regarding “essential documentation”

45Planning Infrastructure Which is the appropriate Planning Unit? State Hospital Health System Community Region

46Planning Infrastructure Who should be on the CRAG?

47Planning Infrastructure Expectations  There will be [#] meetings for this CRAG.  The meetings will be held [dates] at [place].  [Name] will facilitate each meeting.  [$] will be budgeted to this group for expenses incurred.  Each member will be compensated [$].

48Planning Infrastructure Evaluation and Maintenance

49Planning Infrastructure Which is the appropriate Planning Unit? State Hospital Health System Community Region

50Planning Infrastructure Who should be on the CRAG?

51Planning Infrastructure Expectations  There will be [#] meetings for this CRAG.  The meetings will be held [dates] at [place].  [Name] will facilitate each meeting.  [$] will be budgeted to this group for expenses incurred.  Each member will be compensated [$].

52Planning Infrastructure Approval and Integration

53Planning Infrastructure Which is the appropriate Planning Unit? State Hospital Health System Community Region

54Planning Infrastructure Who should be on the CRAG?

55Planning Infrastructure Expectations  There will be [#] meetings for this CRAG.  The meetings will be held [dates] at [place].  [Name] will facilitate each meeting.  [$] will be budgeted to this group for expenses incurred.  Each member will be compensated [$].

56Planning Infrastructure Communication Plans  Develop a communication strategy tailored to providers  Develop a communication strategy tailored to patients  Develop a communication strategy tailored to partners of the hospital(s) in the Planning Unit  Develop a communication strategy tailored to the public  Develop a communication strategy tailored to the press  Develop a communication strategy tailored to politicians

57Planning Infrastructure Which is the appropriate Planning Unit? State Hospital Health System Community Region

58Planning Infrastructure Who should be on the CRAG?

59Planning Infrastructure Expectations  There will be [#] meetings for this CRAG.  The meetings will be held [dates] at [place].  [Name] will facilitate each meeting.  [$] will be budgeted to this group for expenses incurred.  Each member will be compensated [$].

60Planning Infrastructure Questions?