1. © SMS, Inc., 20101 “The Joint Commission ® ’s Standards related to Emergency Preparedness” Presented by: William M. Wagner, ScD CHCM CHSP CHEP Vice President & Director of Education, Research & Development SAFETY MANAGEMENT SERVICES, INC. (877) 577-6550 ** info@safemgt.com APIC Annual Conference New Orleans July 12, 2010

2. © SMS, Inc., 20102 Ready for any emergency?

3. © SMS, Inc., 20103 Provide for patients Protect the staff Preserve the facility Initial Emergency Response

4. © SMS, Inc., 20104 Physical Event Model Emergency Infrastructure intact Sustainable services Disaster Infrastructure damaged Sustainable services Catastrophe Infrastructure damaged Not sustainable services

5. © SMS, Inc., 20105 Patient Care Event Model Emergency Standard care Response capability high Disaster Sufficient care Staff shortage Able to sustain for 96 hours Catastrophe Basic/primitive care Evacuation maybe necessary

6. © SMS, Inc., 20106 Joint Commission Standards Emergency Management (EM.01.01.01 – EM.03.01.03) Infection Control (IC.01.06.01)

7. © SMS, Inc., 20107 EM Standards Planning (EM.01.01.01) Identifying & planning for emergencies Implementation (EM.02.01.01-.15) Developing emergency response Evaluation (EM.03.01.01-03) Testing & analysis of the Plan

8. © SMS, Inc., 20108 EM Components Hazard Vulnerability Analysis (HVA) Emergency Operations Plan (EOP) Emergency Response Plans (ERP) Incident Command Structure (ICS) Staff Training & Exercises

9. © SMS, Inc., 20109 Infection Control Standards Planning (IC.01.01.01-.01.06.01) Responsibilities, resources, plans, & assessments Implementation (IC.02.01.01-.02.04.01) Developing prevention & control activities Evaluation and Improvements (IC.03.01.01) Effectiveness of Program

10. © SMS, Inc., 201010 Prepares to Respond to Influx (IC.01.06.01) Information about infections that can cause influx Clinical & epidemiological information on new infections Methods for communicating information Plan to respond to influx, or not! Methods for managing influx patients Activities to respond to influx

11. © SMS, Inc., 201011 Planning: Hazard Vulnerability Analysis (HVA)

12. © SMS, Inc., 201012 Conducting the HVA Involvement of Leadership, including medical staff Identify “ potential ” hazards, threats & events Evaluate likelihoods & consequences Assess effect on hospital or community

13. © SMS, Inc., 201013 Organizational HVA Develop one, overall HVA Develop a separate HVA for each site: Ambulatory Surgery Center Emergency Clinic Home Health Hospice Hospital

14. © SMS, Inc., 201014 © SMS, Inc., 2008-2009 Hazard Vulnerability Analysis 1= 100% prepared or insignificant 2= 75% prepared or minor 3= 50% prepared or moderate 4= 25% prepared or serious 5= 0% prepared or very serious

15. © SMS, Inc., 201015 © SMS, Inc., 2008-2009 © SMS, Inc, 2008 Hazard Vulnerability Analysis ) (Likelihood) EVENT Likelihood of Occurrence Scoring of Capabilities and Consequences (Table 2) Total Score Communications Failure21632 Pandemic31339 Contaminated Victim112 Electrical Failure111 Hazmat Internal110 Generator Failure118 Ice and Snow31854 Mass Casualty21326 Severe Weather113 Scoring Criteria 1= Minimal or slight probability 2= Moderate probability 3= High probability

16. © SMS, Inc., 201016 Infection Control Standards Response to Influx (IC.01.06.01) Information about infections that can cause influx Clinical and epidemiological information on new infection Methods for communication information Plan to respond to influx (could be no) Methods for managing influx patients Activities to respond influx

17. © SMS, Inc., 201017 Influx vs. Surge Influx = managing patients waiting to receive care at a rate higher than normal –Triage –Registration Surge = managing patients within the organization at a greater rate than its current/normal resources can manage –Capacity –Capability

18. © SMS, Inc., 201018 Surge Capacity & Capability Capacity = having the physical resources & manpower abilities to manage a sudden influx of patients Capability = having specialized competencies & resource capabilities to treat specific groups of patients, infectious patients from a pandemic event

19. © SMS, Inc., 201019 Implementing: Emergency Operations & Response Plans

20. © SMS, Inc., 201020 Six Critical Functions (EM.02.02.01-.02.02.11) Communication Management Resources & Assets Management Security & Safety Management Staff Role & Responsibility Utility Systems Management Patient Management

21. © SMS, Inc., 201021 Six Critical Functions Events Communication Res Assets Safety Security Staff Roles Utility Systems Patient Care Severe Weather Epidemic DOH Numbers Points of Control Pages, cell, etc PPE Reuse Allocation Lockdown HICS Negative Air Systems Screening Triage Isolation Contaminated Victim Electrical Failure Mass Casualty

22. © SMS, Inc., 201022 Emergency Plans Emergency Operations Plan (EOP) –Overall Plan Emergency Response Plan (ERP) –Event Specific Emergency Plan Incident Action Plan (IAP) –A “To Do List” developed during the event Job Action Sheet (JAS) –Guide for Specific Role

23. © SMS, Inc., 201023 Emergency Operations Plan “ A process to respond to any emergency ” Revised 2/2010

24. © SMS, Inc., 201024 Emergency Operations Plan Blueprint for responding to any emergency Information that can be used for any event Easy reference with tabbed sections Include information requested by The Joint Commission

25. © SMS, Inc., 201025 Emergency Initiation Process

26. © SMS, Inc., 201026 Emergency Influx Response Plan “Receiving patients at an increased rate” Revised 6/2010

27. © SMS, Inc., 201027 Plans to respond to emergencies Emergency Response Matrix Emergencies Emergency Response Plans & Procedures ( to contend with the emergency) Bomb Threat Communication Failure Contagious Victim Contaminated Victim (Decon) Evacuation Generator Failure Infant/Child Abduction Patient Influx Lockdown Mass Casualty Security Incident Shelter in Place Staff Shortage Supply Shortage Patient Surge Utility Failure Workplace Violence Epidemic/Pandemic √ √√√√ √√√ Generator Failure √ √√ √ √ Infant/Child Abduction √ √ √ Internal Disaster √√ √√√ √ √ Internal Hazmat Spill √√ √√ √ √ Mass Casualty √√ √√√√ √√√ Severe Weather √ √ √√√ √ Snow/Ice Storms √ √ √√√ √ Structural Failure √ √√√ √√ √ Terrorism √ √√ √ √√√√√√ Utility Failure √√ √ √ √ Workplace Violence √ √ √√ √

28. © SMS, Inc., 201028 Four Key Elements in the Emergency Response Plans Mitigation Preparedness Response Recovery

29. © SMS, Inc., 201029 Four Key Elements in the Emergency Response Plan Mitigation - actions taken before event to limit impact –Provide appropriate Airborne Infectious Isolation Rooms –Purchase appropriate PPE Preparedness - actions taken to ensure organization is prepared –Train staff to manage “concerned” patients –Provide security procedures

30. © SMS, Inc., 201030 Four Key Elements in the Emergency Response Plan Response - actions taken during event –Active EOP & ERP –Initiate infection prevention measures Recovery - actions taken to re-establish organization’s response capacity –Evaluate response –Update plans based on the evaluation –Resupply consumables –Service equipment used during the event

31. © SMS, Inc., 201031 Incident Action Plan (IAP) Outline initial response activities (“back of the envelope”) Utilize information in ERP Identify specific objectives based on current events Formulate into current “Response Plan” for organization Review & revise periodically

32. © SMS, Inc., 201032 Influx Response Plan 1. Response Plan: Immediate (Operational Period 0-2 Hours) A. Goal To manage an increase number of patients with serious conditions B. Operational Time-Frame IAP review: within 2 hours of ICS Activation Operational Shift: 12 hours Planned Duration of Self Sustained Operations: 96 hours C. Objectives * To ensure essential patient security and services are maintained * To prepare the facility for increase patients in ER * To process individuals in an expeditious and organized manner D. Resources Personnel: Staff retained until next operation period or event is over Food: Refrigeration is required for food supplies Clinical Supplies: Refrigeration is required for blood and drugs. Sufficient supplies on hand for most items for short term (less than 24 hours). Inventory, planning and re-supply efforts will be considered for longer term events. Non-clinical Supplies: Re-supply will be considered for longer term events. Utilities (Assets) Support: Support lighting for night time events, electrical support for additional data entry equipment E. Tasks * Open Emergency Operations Center (EOC) - fill essential posts * Obtain appropriate PPE and supplies. * Ensure emergency room is secure * Surge existing ER patients * Obtain additional PPE supplies for ER * Take out Emergency Power Distribution System Chart F. Security Institute lockdown procedure if necessary

33. © SMS, Inc., 201033 Incident Action Plan (0-2 Hours) Objectives & Task (0-2 Hrs) 1. Clear snow from ER entrance 2. Provide security at ER entrance 3. Surge current ER patients to other locations 4. Obtain additional respirators & PPE 5. Identify common symptoms

34. © SMS, Inc., 201034 Job Action Sheets (JAS) Information tool Radio “contact” title Purpose Reporting structure Critical action considerations Prompts actions related to their roles & responsibilities

35. © SMS, Inc., 201035 Incident Command Structure (HICS)

36. © SMS, Inc., 201036 HICS Management Functions Incident Commander Operations Section Chief Planning Section Chief Logistics Section Chief Finance/Admin Section Chief Public Information Officer Safety Officer Liaison Officer Medical/Technical Specialist

37. © SMS, Inc., 201037 Operations Section Chief Medical Care Branch Director Infrastructure Branch Director HAZMAT Branch Director Security Branch Director Casualty Care Leader Building/Grounds Leader Casualty Care Decon Leader Access Control Leader Clinical Support Leader Environmental Services Leader Detection/Monitoring Leader Crowd Control Leader Business Continuity Branch Director Inpatient Leader Mental Health Leader Outpatient Leader Patient Registration Leader Food Services Leader Medical Gas Leader Medical Devices Leader HVAC Leader Power/Lighting Leader Water/Sewer Leader Business Relocation Leader Information Technology Leader Victim Decon Leader Traffic Control Leader Staging Manager Equipment/Supply Staging Leader Medication Staging Leader Records Preservation Leader

38. © SMS, Inc., 201038 Planning Section Chief Resources Leader Situation Leader Documentation Leader Demobilization Leader Patient Tracking Manager Bed Tracking Manager Personnel Tracking Manager Material Tracking Manager Staff Personnel Tracking Manager Physician Tracking Manager

39. © SMS, Inc., 201039 Logistics Section Chief Service Branch Director Support CommunicationsLeader IT/ISLeader Staff Food & Sleep Leader Employee Health Leader Family Care Leader Leader SupplyLeaderFacilities TransportationLeader Labor Pool & CredentialingLeader Alternate Care Site Leader

40. © SMS, Inc., 201040 Finance Section Chief ProcurementLeader CostLeader Compensation/ClaimsLeader TimeLeader

41. © SMS, Inc., 201041 Develop process for monitoring resources needed during an emergency Determine sustainability with existing resources Identify consumption adjustments Plan for evacuation if things get worse Resources & Assets

42. © SMS, Inc., 201042 Evaluation EM.03.01.03: Testing & Exercise ●Communication internal & external ●Resources mobilization & allocation ●Safety & security activities ●Staff roles & responsibility ●Utility systems ●Patient clinical & support activities

43. © SMS, Inc., 201043 43 Critique of Critical Functions Critical Functions GoodFair Opportunities for Improvement Comments Communication Resource Mobilization & Allocation Safety & Security Roles & Responsibilities Utility Systems Patient Management Monitor(s)

44. © SMS, Inc., 201044 Improvement Process HVA Preparation Implementation TrainingEvaluation Committee Review Planning

45. © SMS, Inc., 201045 Survey Preparation Summary Evaluate emergencies with HVA Plan response through EOP Develop specific ERPs Participate in HICS Identify resources and assets Evaluate response to events Improve with committee review

46. © SMS, Inc., 201046 Contact Information SAFETY MANAGEMENT SERVICES, INC. (877) 577-6550 info@safemgt.com www.safemgt.com