1. Hospital Preparedness Program (HPP) & Public Health Emergency Preparedness (PHEP) Grant Alignment 10/20121 Kansas Regional Preparedness Training 2012

2. Grant Alignment Requirement White House directed – Better alignment of emergency preparedness programs HPP and PHEP awardee requested – Reduce duplicative/conflicting activities and redundancies  DHHS preparedness awards nearing $1 billion annually Funding sustainability requires demonstration of how funding has: – Increased operational efficiencies – Improved preparedness integration across the federal government, with partners and with the public – Improved national public health and medical preparedness 10/20122 Kansas Regional Preparedness Training 2012

3. HPP-PHEP Cooperative Agreement Capabilities-based approach Building upon the strong preparedness foundation already in place Benefits – More coordinated and integrated public health and healthcare service delivery system planning and response – Improved ability to leverage funding for applicable activities and infrastructure – Reduced burden regarding duplicative and conflicting activities and reporting 10/20123 Kansas Regional Preparedness Training 2012

4. Aims to broaden the scope of the healthcare service delivery systems preparedness from individual facilities to diverse regional healthcare coalitions (HCC) Allows program to identify gaps in preparedness, determine specific priorities, and develop plans for building and sustaining specific capabilities Shift from Building to Strengthening 10/20124 Kansas Regional Preparedness Training 2012

5. 10/20125

6. Healthcare Coalition (HCC) 10/20126

7. Health and Human Services Definition of healthcare coalition (HCC): A collaborative network of healthcare organizations and their respective public and private sector response partners that serve as a multiagency coordinating group to assist with preparedness, response, recovery, and mitigation activities related to healthcare organization disaster operations. Healthcare Coalition (HCC) 7 Kansas Regional Preparedness Training 2012

8.  One individual agency/organization  Two individual agencies/organizations  Hospital-only regional group  Public health-only regional group  A deployable response team  Made up primarily of individuals, but of organizations A Multi-agency coordination group that includes multiple healthcare organization members (HCOs) within the response community A collective team that assists Emergency Management and Emergency Support Function (ESF) #8 partners A collaborative effort to plan, organize, equip, train, exercise, evaluate and outline corrective actions IS NOT IS 10/20128

9. Conduct non-preparedness or non-response related activities or business “Command” the actions of Coalition members or any other response entities it might interact with during an emergency Use only one county-level Hazard Vulnerability Assessment (HVA) for substitution of the entire regional HVA Focus on the cycle of preparedness, response, recovery, and mitigation activities Promote situational awareness for HCOs Conduct regional healthcare coalition meetings Engage partners in Hazard Vulnerability Assessment (HVA) discussions DOES NOT DOES 10/20129

10. Have to own the electronic systems being shared or utilized within the region Have to have the resources locally, but have access to resources within the region Have the ability to share Essential Elements of Information (EEIs) data electronically across the HCC (e.g., bed status) Utilize subject matter experts from across the region for information sharing DOES NOT DOES 10/201210

11. 10/2012 Healthcare Coalition (HCC) Primary Function of HCC Sub-state regional healthcare system emergency preparedness activities involving the healthcare member organizations (HCOs). This includes planning, organizing, equipping, training, exercises and evaluation. Purpose of HCC Healthcare system-wide approach for preparing for, responding to, and recovering from incidents that have a public health and medical impact in the short-and long-term. 11

12. 10/2012 Healthcare Coalition (HCC) Response of HCC HCCs should represent healthcare organizations by providing multi-agency coordination advice on decisions made by incident management regarding information & resource coordination Advice through: A multi-agency coordination group to assist incident management (area command or unified command) OR Through coordinated plans to guide decisions regarding healthcare organization support 12

13. 10/2012 Hospitals (at least 1) Public health EMS providers Emergency Management Mental/behavioral health providers Long-term care providers Specialty service providers (e.g., dialysis, pediatrics, woman’s health, stand alone surgery, urgent care) Primary care providers Community Health Centers Tribal Healthcare Other healthcare providers County Coroner Public safety Private entities associated with healthcare (e.g., Hospital associations) Support service providers (e.g., laboratories, pharmacies, blood banks, poison control) Federal entities (e.g., NDMS, VA hospitals, IHS facilities, Department of Defense) Volunteer Organizations Active in Disaster (VOAD) Faith-based Organizations (FBOs) Community-based Organizations (CBOs) Volunteer medical organizations (e.g., American Red Cross) Healthcare Coalition Member Organizations (HCO) 13 Kansas Regional Preparedness Training 2012

14. Healthcare Coalition (HCC) 10/201214 Kansas Regional Preparedness Training 2012

15. 10/2012 Regional-based preparedness programs already in place Common purpose: – To serve as a collaborative network of healthcare organizations to assist with preparedness, response, recovery, and mitigation activities related to healthcare organization disaster operations. 15 Kansas Regional Preparedness Training 2012

16. Don’t Recreate the wheel! Use existing networks. Kansas Healthcare Coalitions 10/201216 Kansas Regional Preparedness Training 2012

17. 10/2012 Most states are choosing to utilize their current regional structure for healthcare coalitions Some are using State as one coalition Few states are using city or county based communities Non-Kansas Healthcare Coalitions 17 Kansas Regional Preparedness Training 2012

18. 10/201218 Kansas Regional Preparedness Training 2012 Five Year Grant Period Working in close collaboration with internal and external subject matter experts (SMEs), ASPR and CDC developed a set of new performance measures for 2012-2013 that enable ASPR and its HPP awardees to: Enhance situational awareness Provide technical assistance Support program improvement and inform policy Increase transparency Promote sound stewardship of Federal tax dollars by using the data to assess impact of public funding and ensure that the American taxpayer sees a return on his or her investment. – The development of program measures and continuous quality improvement enables Healthcare Systems Evaluation Branch (HSEB) within ASPR to critically evaluate the ability of the HPP program to perform its intended goals.

19. 10/2012 The Assistant Secretary for Preparedness and Response (ASPR) has always supported region-based approaches for preparedness planning. This has been a part of the preparedness program for many years. You can learn more from the ASPR 2009 report, From Hospitals to Healthcare Coalitions: Transforming Health Preparedness & Response in Our Communities. In this report, ASPR highlighted the seven Kansas regional hospital groups as a best practice for collaborative efforts resulting in shared resources and stronger relationships. This is the structure that will continue to be used moving forward.From Hospitals to Healthcare Coalitions: Transforming Health Preparedness & Response in Our Communities 19 Kansas Regional Preparedness Training 2012

20. 10/201220 Kansas Regional Preparedness Training 2012

21. 10/2012 Challenges & Solutions Challenge Example #1: Preparedness funding realities Possible Solutions: Capitalize on policy initiatives and resources Military. Force Multiplier--A capability that, when added to and employed by a combat force, significantly increases the combat potential of that force and thus enhances the probability of successful mission accomplishment. Racing. Drafting or slipstreaming is a technique where two vehicles or other moving objects are caused to align in a close group reducing the overall effect of drag Collaboration Effect 21 Kansas Regional Preparedness Training 2012

22. National Healthcare System Gap Coalitions Regional Preparedness 100% Prepared Collaboration Effect 10/201222 Kansas Regional Preparedness Training 2012

23. National Healthcare System 100% Prepared Gap Coalitions Regional Preparedness Collaboration Effect 10/201223 Kansas Regional Preparedness Training 2012

24. National Healthcare System 100% Prepared Achieving Success 10/201224 Kansas Regional Preparedness Training 2012

25. Challenges & Solutions Challenge Example #2: Coalition integration into disaster response Possible Solution: 10/201225 Kansas Regional Preparedness Training 2012

26. 10/2012 Challenges & Solutions Challenge Example #3: “surge” capacity “Surge” capacity is shrinking Possible Solution: Coalition immediate bed availability  Immediate bed availability (IBA) is built into the existing system  Uses regional capacity  Expanding local capabilities  Builds on current regional structures  Builds on regional collaboration IBA principles Constant acuity monitoring across the coalition Patient awareness and continuous discharge planning 20% acute care offload (IBA) 26 Kansas Regional Preparedness Training 2012

27. Immediate Bed Availability 10/201227 Kansas Regional Preparedness Training 2012

28. Stroke/MIs High Acuity Psychiatric patients ICU Patients Acute Surgical Patients Imminent OB delivery Lesser Acuity Awaiting discharge Behavioral Health Issues Social Issues Post Operative Patients Elective Procedures Cancelled Home Community Health Centers Long Term Care Acute HospitalsCoalition Partners 20% EVENT Coalitions & Immediate Bed Availability 10/201228 Kansas Regional Preparedness Training 2012

29. Coordinated near- simultaneous attacks targeting commuter trains 191 dead More than 2,600 injured Challenges & Solutions Case Study: Madrid 3/11/2004 10/201229 Kansas Regional Preparedness Training 2012

30. Challenges & Solutions Case Study: Madrid 3/11/2004 10/201230 Kansas Regional Preparedness Training 2012

31. Challenges & Solutions Case Study: Madrid 3/11/2004 10/201231 Kansas Regional Preparedness Training 2012

32. 1000 acute care beds/coalition 20% IBA Results in 200 beds immediately avail/coalition 100 coalitions in the United States Across the U.S., 20,000 beds available— immediately Madrid = 2,000 patients -R-Require 10 coalitions engaged Challenges & Solutions Functional IBA? Discussions across HCCs 10/201232 Kansas Regional Preparedness Training 2012

33. Resources Best Practices 10/201233 Kansas Regional Preparedness Training 2012 Coalition Strengthening Documents

34. 10/201234 Kansas Regional Preparedness Training 2012

35. 10/2012 Kansas defined Tier 1-4 Coordination 35 Kansas Regional Preparedness Training 2012