1. U.S. Hospital Support for Major Emergencies Megan R. Angelini Senior Fellow American College of Healthcare Executives

2. 1. Who is in charge of setting up the emergency response and what is the role of hospitals in this planning process? 2

3. Policies Regarding Responsibilities Model State Emergency Health Powers Act –Grants public health powers to state and local public health authorities –Ensures strong, effective and timely planning, prevention, and response mechanisms to public health emergencies while also respecting individual rights 3 Source: The model state emergency health powers act (MSEHPA). The Centers for Law and the Public’s Health

4. Policies Regarding Responsibilities State Emergency Response Commission –Designates and coordinates the activities of Local Emergency Planning Committees (LEPC) Must develop a community emergency response plan that involves key contributors, including hospitals Must designate a local hospital that has agreed to accept and treat victims of emergency incidents 4 Source: OSHA 3152 Hospitals and community emergency response – what you need to know.

5. Hospital’s Role in Planning Process The hospital must define its role in community emergency response by pre-planning and coordinating with other local emergency response organizations as described by LEPCs Preparedness Testing (Joint Commission) ̶ Requires accredited hospitals to implement emergency response plan twice per year 5 Source: OSHA 3152 Hospitals and community emergency response – what you need to know.

6. Hospital’s Role in Planning Process Ensure compatibility between their emergency response plan and others in the community Identify alternative care sites Plan communications both into and out of the hospital Arrange surge supply sources for critical resources (i.e. people, equipment, food, and medical supplies) Train staff and participate in community-wide drills 6 Source: Standing together – an emergency planning guide for America’s communities. The Joint Commission.

7. 2. Is there a specific organizational framework in place giving specific roles to hospitals and how it is enforced? 7

8. Organizational Frameworks Based off of two basic principles: –Organizational structure to respond to daily issues should form the basis of an expanded structure that prepares for and handles disasters –Must be flexible to readily expand as needed to match the demands of the disaster 8 Source: Lindell, M.; Prater, C.; Perry R. (2006). Fundamentals of emergency management. FEMA Emergency Management Institute.

9. The Metropolitan Medical Response System (MMRS) Supports the integration of emergency management, health, and medical systems into a coordinated response to mass casualty incidents caused by any hazard Links multiple response systems –Vertical linkages –Horizontal linkages 9 Source: Lindell, M.; Prater, C.; Perry R. (2006). Fundamentals of emergency management. FEMA Emergency Management Institute.

10. National Incident Management System (NIMS) There are six components to NIMS: ̶ Command and Management ̶ Preparedness ̶ Resource Management ̶ Communication and information ̶ Supporting technologies ̶ Ongoing management and maintenance 10 Source: Lindell, M.; Prater, C.; Perry R. (2006). Fundamentals of emergency management. FEMA Emergency Management Institute.

11. 3. Do hospitals have resources to go on site or is it organized to receive the victims? 11

12. Planning for Care Location of care impacted by the location and magnitude of the disaster Also, largely dependent on surge capacity of each hospital –Ability to expand care capabilities in response to sudden or more prolonged demand –Accounts for both a point in time and longitudinal patient care requirements 12 Source: Standing together – an emergency planning guide for America’s communities. The Joint Commission.

13. 4. How are the staff identified, trained and mobilized to participate in emergencies? 13

14. Identifying Staff Individuals responsible for responding to a disaster situation Examples of individuals who should be trained: Emergency physicians Emergency department nurses and aids Support personnel such as respiratory therapists Security and maintenance personnel 14 Source: Standing together – an emergency planning guide for America’s communities. The Joint Commission.; OSHA 3152 Hospitals and community emergency response – what you need to know.

15. Training Staff Based on duties and responsibilities Training process involves: ̶ Outlining the response plan’s requirements to administrators and personnel of the departments that are involved in responding to emergencies ̶ How to perform required roles and responsibilities for each member 15 Source: OSHA 3152 Hospitals and community emergency response – what you need to know.; Standing together – an emergency planning guide for America’s communities. The Joint Commission.

16. Mobilizing Staff To effectively mobilize staff ̶ Personnel roles and responsibilities, training and communications must be included within the hospital’s overall emergency response plan 16 Source: OSHA 3152 Hospitals and community emergency response – what you need to know.

17. 5. What is the financial mechanism to support catastrophe preparedness and responses and what is the assessment of this mechanism from the perspective of hospitals? 17

18. Policies Regarding Assistance The Governor of a state in which a serious event occurs can request federal assistance, or the President can declare a “major disaster” or “emergency” on his own If the President declares an emergency, the Federal Emergency Management Agency is authorized to provide financial assistance 18 Source: FEMA – The Disaster Process and Disaster Aid Programs; McGlown, K. Terrorism and disaster management – preparing healthcare leaders for the new reality.

19. Eligibility Process Three part analysis to determine eligibility and amount of financial assistance –Is the particular person – the legal entity – applying for assistance eligible? –Is the particular work eligible? –Are the costs incurred in performing the eligible work reasonable? 19 Source: FEMA – The Disaster Process and Disaster Aid Programs; McGlown, K. Terrorism and disaster management – preparing healthcare leaders for the new reality.

20. Eligible Healthcare Organizations Healthcare entities eligible to apply for direct assistance from FEMA: –One that is owned by a state or local government or public authority –Not-for-profit institutions, providing essential government-type services to the general public –Critical services 20 Source: FEMA – The Disaster Process and Disaster Aid Programs; McGlown, K. Terrorism and disaster management – preparing healthcare leaders for the new reality.

21. Eligible Healthcare Costs Costs that are eligible for direct assistance –Incurred to address imminent threats of harm to life, property, and the public health and safety –Repair, restore, reconstruct, or replace damaged facilities Costs that might get reimbursed indirectly –Funds that allows individuals to pay emergency medical bills –Crisis counseling services 21 Source: FEMA – The Disaster Process and Disaster Aid Programs; McGlown, K. Terrorism and disaster management – preparing healthcare leaders for the new reality.

22. 6. Is there a special set up for mobilizing hospitals for international emergencies, what is the experience? 22

23. Hospital Mobilization for International Emergencies There is no systematic method of response for all US hospitals to mobilize for a catastrophic event However, there are mechanisms within: –Hospital systems and groups Example - Stanford Emergency Medicine Program for Emergency Response (SEMPER) –State hospital associations and regional governmental systems 23 Source: U.S. Department of Health & Human Services. International Preparedness and Response.; Special team will mobilize for global disasters. Stanford Medicine.

24. 7. Are there any major on-going debate at local or national level on hospital mobilization for large emergencies? 24

25. Ongoing Debate Unwillingness of government to fund capacity building to prepare for disasters –Imbalance between mandates and funding 25

26. Resources 1.(1997). OSHA 3152 Hospitals and community emergency response – what you need to know. Emergency Response Safety Series. United States Department of Labor. https://www.osha.gov/Publications/OSHA3152/osha3152.htmlhttps://www.osha.gov/Publications/OSHA3152/osha3152.html 2.(2005). Altered Standards of Care in Mass Casualty Events. Prepared by Health Systems Research Inc. under Contract No. 290-04-0010. AHRQ Publication No. 05-0043. Rockville, MD: Agency for Healthcare Research and Quality. 3.(2006). Standing together – an emergency planning guide for America’s communities. The Joint Commission. http://www.jointcommission.org/Standing_Together__An_Emergency_Planning_G uide_for_Americas_Communities/ http://www.jointcommission.org/Standing_Together__An_Emergency_Planning_G uide_for_Americas_Communities/ 4.(2008). The model state emergency health powers act (MSEHPA). The Centers for Law and the Public’s Health: A Collaborative at Johns Hopkins and Georgetown University. http://www.publichealthlaw.net/ModelLaws/MSEHPA.phphttp://www.publichealthlaw.net/ModelLaws/MSEHPA.php 26

27. Resources 7.(2011). Special team will mobilize for global disasters. Stanford Medicine. http://med.Stanford.edu/news/all-news/2011/07/special-team-will-mobilize-for- disasters.html http://med.Stanford.edu/news/all-news/2011/07/special-team-will-mobilize-for- disasters.html 8.(2013). U.S. Department of Health & Human Services. International Preparedness and Response. http://www.phe.gov/preparedness/international/pages/default.aspxhttp://www.phe.gov/preparedness/international/pages/default.aspx 9.(2014). FEMA – The Disaster Process and Disaster Aid Programs. http://www.fema.gov/disaster-process-disaster-aid-programs. http://www.fema.gov/disaster-process-disaster-aid-programs 10.(2014). Hampton Roads Metropolitan Medical Response System. http://www.hrmmrs.org/ http://www.hrmmrs.org/ 11.Carter, J.; Slack, M. (2010). Pharmacy in public health - basics and beyond. http://www.ashp.org/doclibrary/bookstore/p1725/p1725samplechapter.aspx. http://www.ashp.org/doclibrary/bookstore/p1725/p1725samplechapter.aspx 12.Lindell, M.; Prater, C.; Perry R. (2006). Fundamentals of emergency management. FEMA Emergency Management Institute. http://training.fema.gov/hiedu/aemrc/booksdownload/fem/ http://training.fema.gov/hiedu/aemrc/booksdownload/fem/ 13.McGlown, K. (2004). Terrorism and disaster management – preparing healthcare leaders for the new reality. Chicago: HAP. 27

28. U.S. Hospital Support for Major Emergencies Megan R. Angelini Senior Fellow American College of Healthcare Executives