1. Mass Fatality Management Guide for Healthcare Entities

2. AGENDA Project Overview – History – Goal and Objectives – Methodology Guide Review – Scope – Organization – Content Next Steps – Implementation 3

3. Mass Fatality Management Guide for Healthcare Entities 4 2008 MFI GUIDE REVIEW The 2008 goal was to develop a guidance document for hospitals to enhance the ability of Los Angeles County and its healthcare partners to manage a surge in the number of decedents as a result of pandemic flu outbreak Developed by EMS, Coroner and DPH

4. Mass Fatality Management Guide for Healthcare Entities 2011-2013 GOAL AND OBJECTIVES Revise/Enhance Guide – Brings in best practices/lessons learned Expanded throughout 2012 – Provides specific, tangible, and quantifiable recommendations Tested during Statewide exercise – Provides an accompanying online toolkit Expanded as part of vetting process – Addresses the nexus between healthcare entities, and other local agencies in the fatality management planning process Tested during Statewide Medical and Health Exercise – Addresses the legal and regulatory issues 4

5. Mass Fatality Management Guide for Healthcare Entities RELEVANCE TO OTHER MASS FATALITY RESOURCES The 2008 version was consistently recognized as one of the best resources available on mass fatality management at the time of its release. It is regularly referenced in other jurisdictional mass fatality plans The new version is a benchmark in mass fatality planning efforts 4

6. Mass Fatality Management Guide for Healthcare Entities METHODOLOGY Identify Key Stakeholders – Project Oversight Group – Interviewees/SME – Reviewers Timeline: September 2011 to January 2013 6

7. Mass Fatality Management Guide for Healthcare Entities BASE Acknowledgements Overview – Background, Scope, Objectives – Guide Development Process – How to Use Guide Plan Development – Writing the Plan – Training, Exercise – Special Considerations Activation – Tiered Escalation Levels – Logistics, Staffing – Notify Stakeholders – JIT, Initial Briefing Operation – NOK Notification – Decedent Identification, Processing, Transfer, Tracking Demobilization

8. Mass Fatality Management Guide for Healthcare Entities APPENDICES Community-wide Response Matrix Key contacts HIPAA Security Internet Resources Refrigeration Truck Storage Mental and Behavioral Health Resources Religious and Cultural Resources Fact Sheets Glossary Acronyms 8 ONLINE RESOURCES Mass Fatality Management Guide for Healthcare Entities Forms Triage Tag Training Mass Fatality Management Plan Template Job Action Sheet Guide Slide Presentation ONLINE RESOURCES Mass Fatality Management Guide for Healthcare Entities Forms Triage Tag Training Mass Fatality Management Plan Template Job Action Sheet Guide Slide Presentation

9. Mass Fatality Management Guide for Healthcare Entities KEY SECTION REVIEW Plan Activation – Key Position Checklist – Physician-in-Charge Concept – Witness Form Decedent Processing Death Certificates & CA-EDRS Decedent Tracking Decedent Handling and Storage Community-wide Response Matrix Refrigeration Truck Storage Religion and Culture Fact Sheets

10. Mass Fatality Management Guide for Healthcare Entities PLAN ACTIVATION Identify triggers for plan activation & escalation Plan activation likely in concert with ICS activation Actions organized via six step process Staffing Guidelines – Organized by facilities with/without morgues and escalation tier

11. Mass Fatality Management Guide for Healthcare Entities KEY POSITION CHECKLIST Decedent Affairs Group Supervisor – Based on HICS, can (and should!) be tailored – Developed as part of larger emergency response approach – Tasks in chronological order

12. Mass Fatality Management Guide for Healthcare Entities PHYSICIAN-IN- CHARGE Certain physicians are designated to sign death certificates – NOT for Coroner’s cases Most MFIs involve Coroner cases – May pertain to widespread communicable disease events ADMIN STAFF Gather as much information as possible regarding patient – Witness Form

13. Mass Fatality Management Guide for Healthcare Entities DECEDENT PROCESSING Organized in two steps – Step 1– Understand process – Step 2 – Identify ways to expedite Flow chart provided DEATH CERTIFICATES AND CA-EDRS Organized in two steps – Step 1– Understand & document death certificate parameters Non-Coroner’s case process Coroner’s case process – Step 2 – Identify ways to expedite See Fact Sheets – Death Certificates – CA-EDRS – County Public Administrator

14. Mass Fatality Management Guide for Healthcare Entities DECEDENT TRACKING Organized in four steps – Step 1 – Understand tracking process for your facility MCI Example – Step 2 – Document process Hospitals w/ ReddiNet MCI module Hospitals w/o ReddiNet MCI module Medical Clinics SNFs – Step 3 – Identify ways to direct decedents to mortuaries – Step 4 – Identify ways to accommodate NOK who cannot pay

15. Mass Fatality Management Guide for Healthcare Entities DECEDENT HANDLING AND STORAGE Organized in four steps – Step 1 – Determine your surge storage capacity See Surge Storage Capacity Assessment – Step 2 – Ensure decedent handling processes are in place – Step 3 – Expand surge capacity Primary morgue Unused service areas External morgues Temporary burial (ONLY when directed by Coroner) – Step 4 – Ensure P&P

16. Mass Fatality Management Guide for Healthcare Entities COMMUNITY-WIDE RESPONSE MATRIX High-level roles/responsibilities matrix – Healthcare partners, and local, State, Federal partners – Tool for healthcare entity partners to enhance understanding of their role in a community-wide response

17. Mass Fatality Management Guide for Healthcare Entities REFRIGERATION TRUCKS FOR STORAGE Capacity – # of decedents that can be stored by truck size – NOT for transportation – storage only – Increase capacity with shelving Procurement – Can procure own – Can request via NIMS/SEMS – Information to provide Reimbursement – Requesting facility to pay – HPPs MAY qualify for reimbursement

18. Mass Fatality Management Guide for Healthcare Entities RELIGION AND CULTURE Organized in two steps – Step 1– Obtain and include information regarding death practices Tailor for your population Sample material included – Step 2 – Confer with cultural and religious organizations in your area FACT SHEETS Death Certificates CA-EDRS Health risks County Public Administrator Recommendations Considerations Decomposition

19. Mass Fatality Management Guide for Healthcare Entities NEXT STEPS Guide implementation – See Plan Development Section – Review existing policy – Review Guide – Revise facility mass fatality plan based on Guide 9

20. Mass Fatality Management Guide for Healthcare Entities