1. Creative NIMS Compliance Building incident management teams to support long term operations Greg Santa Maria Emergency Preparedness Manager Sanford Health System Sioux Falls, SD

2. The Sanford Health System 24 hospitals –Mostly critical access 105 clinics 4 states RURAL SERVICE AREAS

3. How it all began Medical Center main campus update - 2004 –HEICS Updates –Tabletops –Decon Training Random network hospital requests –Emerging patterns What the heck is a Critical Access Hospital?

4. Starting out – the initial projects HEICS training Simple scenarios Realistic events –Webster Elevated awareness of local hazards –Large gatherings –HAZMATS

5. The burning questions How does a critical access hospital with a limited number of employees and resources respond to a large incident in their community? How do they maintain operations over multiple operational periods? How does this also apply to rural fire and EMS?

6. First Things First Effective ICS Training Internet vs classroom –Who is monitoring comprehension? Advanced ICS What about practical applications? –If you needed surgery and your doctor was licensed through an online course, would you put your life in his hands? –Why Incident Command?

7. Walking the Talk ICS NIMS –Five year NIMS training plan Exercises Planning

8. A team is born Wouldn’t it be cool if……… Just like wildland fire fighting, we could develop seasoned and confident incident managers and use them to create incident management teams for our Health System and then beyond…….

9. Sanford Health Incident Management Team Project Job Description Planning Section Chief Nice Vest!!! Hospital use of ICS is limited –ICS is still “new” to hospitals –Still HCC Confusion on roles –Standards are staggered Few have taken ICS 300 / 400

10. Sanford Health Incident Management Team Project Disasters cost money –Why? Long term operations stress staff –Lack of replacement staff –Other issues What about incident commanders –Who replaces them? Decon teams? DisasterBusiness

11. Now is the time Nationwide Emergency Management Expectations The Joint Commission EM Standards Hospital Ops may last longer than scene Ops

13. Sanford Health Incident Management Team Project Scenario 1 – Pre - IMT –Disaster in Winner, SD Isolated location Finite staff Multi period event will stress local resources System plan activation –Takes IC focus from local to system communication –May delay local decision making and IAP

14. Sanford Health Incident Management Team Project Scenario 2 - HIMT –Disaster in Winner Disaster response begins Multi period disaster identified Local SH facilities deploy HIMT support staff On Call Team leader notified Initial Situation Assessment completed If applicable, system plan activated –Team members act as liaisons to local as well as system resources Communications link with Local EM established

15. Activation Pulling the Trigger What barriers to activation exist? –Personal –Administrative Policy –Other –“The Orwell Syndrome”

16. Activation

17. Levels of Activation

18. Sanford Health Incident Management Team Project Project Description Develop a system wide team of responders –Deployable to any system location –Trained to assess a disaster situation and coach a Command center – EOC manager Decon team –On call and on site team leaders that initiate the system response –Trained to coordinate efforts with local emergency managers

19. Sanford Health Incident Management Team Project The concept –On location support Increases morale Reduces business losses Increases response effectiveness over multiple operational periods Does NOT relieve local commander of responsibility –Manager role (not commander)

20. Sanford Health Incident Management Team Project The concept –Liaison between system and affected facility Enhances communication Creates ease of resource management Removes the “distant” responsibilities so IC can focus on local event Allows local staff to maintain continuity of operations

21. Sanford Health Incident Management Team Project The concept –Liaison between affected facility and local EM Establishes “trained” liaison Ensures appropriate use of local resource Reduces potential for duplication of services Knows who to call and when / where to call them

22. Sanford Health Incident Management Team Project The concept –Bring needed support staff to affected facility Decon EOC “coach” Incident managers

23. Sanford Health Incident Management Team Project Incidents start locally –This is not only about “the big one” –Webster SD – Lake Area Hospital – HAZMAT –Can be used for Ice Storms Blizzards Tornado Any incident that will result in multiple operational periods (8+ hours)

24. Sanford Health Incident Management Team Project Current outreach programs –Preparedness evaluation –ICS / NIMS classroom training –Tabletops and functional exercises –Decon training (OSHA 1910.120) –Advanced ICS offerings

25. Sanford Health Incident Management Team Project Coordination of multi agency exercises Winner Chamberlain

26. Basic Steps ICS Training Simple tabletop Decon training Multi agency training Multi agency exercise Multi facility exercises Increasing complexities

27. Sanford Health Incident Management Team Project Sanford HIMT Training Four levels –HAZMAT operations technician –HAZMAT group supervisor –Hospital incident manager –Hospital incident management specialist

28. Level 1

29. Level 2

30. Level 3

31. Level 4 http://www1.va.gov/emshg/page.cfm?pg=122

32. Training Can be modular Can be an immersion program Requires an internship at the highest level Is in development stages and requirements may increase or content may change

33. Sanford Health Incident Management Team Project Team Leaders –Become trainers –Train their facility and other “local” regional facilities –Develop HVA and preparedness assessments –Initiate, script and facilitate local and multi-agency drills –Are our disaster planning liaisons to Responder agencies Health systems Emergency management resources

34. Sanford Health Incident Management Team Project Levels of Activation (not defined) –Level 1 2 Managers and 1 Specialist –Level 2 2 Managers and 1 Specialist with system EP plan activation and main campus liaison –Level 3 Management team with decon support –Level 4 Management team with area command activation

35. What will we accomplish System wide consistent response –Incident command –Decontamination –HVA – Drill development NIMS Compliance The Joint Commission emergency management focus Enhanced Business Continuity Reduction of operational losses due to large events

36. The good news…..a “value added” service Team members exist in most locations –Safety officers –BT coordinators –Volunteer Fire Chiefs and Officers –Emergency Managers –EMS Supervisors

37. Identifying Team Members At least one from each facility required –This is stated as “expected participation” –At least one level 3 at each location –Up to four active participants per facility This will be an active participation project –Nobody just “says” they are participating

38. Utilization in Exercises Area command concept Encourages communication between –Affected facilities –System command center –Local emergency management

39. Area Command Concept Area Command WebsterClear LakeLuverne PlanningOperationsLogisticsFinance PIOLiaison SafetyExpert Sioux FallsCanton PlanningLogistics Finance

40. Command Center Tool eSponder –ICS –Resource Tool –Communication Tool

41. Preparedness is not just meeting a “standard” Its IS –Achieving comfort levels –Gaining knowledge and experience –Denying complacency a place to grow –Motivating the not so interested –IT WILL NEVER HAPPEN HERE

42. What's Next? Expansion outside of health system –Stand alone facilities –Other health systems –Region –State –WHO ELSE?

43. The future Assists implementation of Regional Plans Cross border / Jurisdictional response The “next” big exercises –Worthington, MN –Rock Rapids, IA

44. Who else can benefit? Volunteer FD Large Municipal FD - FDNY is doing it as well EMS Emergency Management –SD doing it!!!

45. The Incident Management Team Achieves numerous elements Supports long term operations Provides EOC Support Provides TRAINED support personnel

46. Thanks to the team

47. Training Resources Department of Veterans Affairs Emergency Management (EM) Principles and Practices for Healthcare Systems http://www1.va.gov/emshg/page.cfm?pg=122 FEMA EMI ICS 100 ICS 200 IS 700 Professional Development Series http://training.fema.gov/IS/crslist.asp California Hospital Association http://www.calhealth.org/public/edu/nims.html AHRQ – EPRI http://www.ahrq.gov/research/epri/

48. Questions???